1.0

2015-08-11 10:00:58

  1. 1. Initial Data Load
    1. 1.1. Juana Mariana Gonzales Initial Data Load
      1. 1.1.1. Enter Initial Demographic Data for New Patient Juana Mariana Gonzales, 6-year old
      2. 1.1.2. Enter Initial Immunization Data for Juana Mariana Gonzales: Immunizations from practice
      3. 1.1.3. Enter Initial Immunization Data for Juana Mariana Gonzales from Another Practice
      4. 1.1.4. Enter Initial Immunization Data for Juana Mariana Gonzales Reported by Parent
      5. 1.1.5. Enter Adverse Reaction to the Polio Vaccine
      6. 1.1.6. Enter allergy to egg albumin
  2. 2. Query and Display Response
    1. 2.1. Patient Juana Mariana Gonzales
      1. 2.1.1. Select Patient Juana Mariana Gonzales
      2. 2.1.2. Query Registry for vaccination history and forecast for Juana Mariana Gonzales
      3. 2.1.3. View and Compare response to request for vaccination history for Juana Mariana Gonzales
      4. 2.1.4. Mark first MMRV Dose as Invalid
      5. 2.1.5. View the vaccination forecast for Juana Mariana Gonzales
      6. 2.1.6. Reconcile and import vaccinations from Evaluated History and Forecast for Juana Mariana Gonzales
      7. 2.1.7. View the updated vaccination forecast for Juana Mariana Gonzales
  3. 3. Order and Immunize patient
    1. 3.1. Juana Mariana Gonzales, Enter Orders and Immunizations
      1. 3.1.1. Order IPV and view prior reaction
      2. 3.1.2. IPV Parental Refusal
      3. 3.1.3. Record MMRV Vaccine administration
  4. 4. Transmit Immunization Report
    1. 4.1. Juana Mariana Gonzales Transmit Immunization Report
      1. 4.1.1. Transmit the immunization report to the Immunization Registry
      2. 4.1.2. Receive Acknowledgement
      3. 4.1.3. Record an adverse reaction
      4. 4.1.4. Transmit the updated vaccination report with adverse reaction to the registry
      5. 4.1.5. Receive Acknowledgement

1. Initial Data Load

The initial Data load will consist of the vendor entering data during live interactive testing for 4 patients with various scenarios. The data entry will include demographic data, Immunization histories and specific conditions for each patient.

1.1. Juana Mariana Gonzales Initial Data Load

Demonstrates the ability to record pediatric demographic data, historical vaccinations, and clinical conditions for 6-year old Juana Mariana Gonzales. There are no transactions associated with this test case.

Test Story

Description

The practice site for the scenario is Shoreline Pediatrics. The EHR vendor loads demographic data and clinical history for Juana Mariana Gonzales. The data includes immunizations provided by the practice.

The vendor also enters:

• Two vaccines administered at other sites

   o an influenza vaccine given at a local pharmacy

   o an inactivated polio vaccine given elsewhere and not reported to the registry – the history includes an adverse reaction (febrile seizure) 8 hours after the vaccine was administered

• Adverse reaction to inactivated polio vaccine (febrile seizure) and the date and source of information

• Allergy to egg albumin administered at this site (the registry has different CVX date and lot number information for this vaccine)

NOTE: the historical vaccines will be imported during the Registry query  (e.g. from another practice)


Comments

Set-up step evaluating EMR functions for capturing and storing patient pediatric demographic data, historical immunizations, and clinical conditions. There is no transaction associated with this test step.


PreCondition

No PreCondition


PostCondition

The EMR has recorded all of the pediatric demographic data, historical immunizations, and clinical conditions  in the record created for Juana Mariana Gonzales using the test data provided.


Test Objectives

No Test Objectives


Evaluation Criteria

No evaluation criteria


Notes to Testers

No Note


1.1.1. Enter Initial Demographic Data for New Patient Juana Mariana Gonzales, 6-year old

Test Step Type: SUT_MANUAL
Juana Mariana Gonzales is entered as a patient in the EMR, including all pediatric demographic information.

Test Story

Description

The EHR vendor loads demographic data for Juana Mariana Gonzales.


Comments

Set-up step evaluating EMR functions for capturing and storing patient pediatric demographic data. There is no transaction associated with this test step.


PreCondition

No PreCondition


PostCondition

The EMR has recorded all of the pediatric demographic  in the record created for Juana Mariana Gonzales.


Test Objectives

Register New Patients: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information.  For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother’s maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient’s information to external systems such as an immunization registry.


Evaluation Criteria

Evaluation Criteria: Vendor successfully records all demographic data provided, and in particular (Mother's maiden name, multiple birth, birth order), with all required attributes indicated by [Y]:

 

  • Patient ID (previously listed as “Medicaid Number”) - Vendor supplied [Y]
  • Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name - Shoreline Pediatrics [Y]
  • Patient ID: Type (e.g., medical record number, IIS ID) - Vendor supplied [Y]
  • Patient Name: First - Juana [Y]
  • Patient Name: Middle - Mariana [Y]
  • Patient Date of Birth - 12/23/2009  [Y]
  • Birth Time - 11:05 [N]
  • Patient Gender (Administrative Sex) - F [Y]
  • Patient Multiple Birth Indicator - No [Y]
  • Patient Birth Order -  NA [C]
  • Responsible Person Name: First - Joanna [Y]
  • Responsible Person Name: Middle - Merida [Y]
  • Responsible Person Name: Last - Gonzales [Y]
  • Responsible Person Name: Relationship to Patient - Grandmother (or Grandparent) [Y]
  • Mother’s Name: First - Maria [Y]
  • Mother’s Name: Middle -Merida [Y]
  • Mother’s Name: Last - Gonzales [Y]
  • Mother’s Name: Maiden Last - Acosta [Y]
  • Patient Address: Street - 4345 Standish Way [Y]
  • Patient Address: City - Stamford [Y]
  • Patient Address: State - CT [Y]
  • Patient Address: Country - US [Y]
  • Patient Address: Zipcode - 06903 [Y]
  • Patient Address: County of Residence - Fairfield [N]
  • Race - Other [Y]
  • Ethnicity - Hispanic or Latino [Y]
  • Birthing Facility Name (Birth Delivery Location Address BDL) - Shoreline Hospital 325 Shorline Drive, Stamford Connecticut 06901  [Y - birthing facility name, not address]
  • Patient Birth State - CT [Y]
  • Patient Primary Language - English [Y]
  • Patient Telephone Number - (203) 555-1212 [Y]
  • Patient Telephone Number Type (e.g., home, cell) - home [Y]
  • Patient E-mail Address - jmg@gmail.com [N]
  • Publicity Code  [N]
  • Protection Indicator [N]
  • Protection Indicator Effective Date [N]
  • Immunization Registry Status [N]
  • Preferred Contact Method - Phone  [Y]

Notes to Testers

No Note


1.1.2. Enter Initial Immunization Data for Juana Mariana Gonzales: Immunizations from practice

Test Step Type: SUT_MANUAL
Patient History from the local practice is entered into the EMR.

Test Story

Description

The EHR vendor loads immunization history data from the local practice for Juana Mariana Gonzales.


Comments

No Comments


PreCondition

The EMR has recorded all of the pediatric demographic in the record created for Juana Mariana Gonzales.


PostCondition

The immunization history  the known to the local practice is loaded into the record created for Juana Mariana Gonzales.


Test Objectives

Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.


Evaluation Criteria

Evaluation Criteria: Vendor successfully records all immunization data known to the local practice as provided, with all required attributes indicated by [Y]:

Vaccine from Practice HepB    
Entered BY Sandra Molina Y
Ordering Provider Frank Smith Y
Entering Organization Shoreline Pediatrics Y
Administration Notes (Vaccine Event information source) New immunization record (NIP001 00) Y
Date/Time of Start of Administration 1/15/2010 Y
Vaccine Administered hepatitis B vaccine, pediatric or pediatric/adolescent dosage  (CVX 08) Y
Administered Amount (of Vaccine) 0.5 Y
Administered Units (of Measure) mL Y
Administering Provider Sandra Molina Y
Administered-at Location 400 Shoreline Drive, Stamford Connecticut 06901 Y
Lot Number 6352FK1 Y
Substance Expiration Date 10/1/2010 Y
Substance Manufacturer Name GlaxoSmithKline Biologicals SA (MVX SKB) Y
Completion Status CP Y
Route of Administration IM Y
Administration Site Right Thigh Y
     
Vaccine from Practice MMRV    
a. Entered BY J. Martinez Y
b. Ordering Provider Frank Smith Y
c. Entering Organization Shoreline Pediatrics Y
Vaccine Event information source New immunization record (NIP001 00) Y
Value/Text for Vaccine Type  MMRV Y
Date/Time of Start of Administration 10/23/2010 Y
Vaccine Administered measles, mumps, rubella, and varicella virus vaccine Y
Administered Amount (of Vaccine) 0.5 Y
Administered Units (of Measure) mL Y
Administration Notes   Y
Administering Provider Sandra Molina Y
Administered-at Location 400 Shoreline Drive, Stamford Connecticut 06901 Y
Lot Number 7W27V7491 Y
Substance Expiration Date 12/15/2010 Y
Substance Manufacturer Name Merck Sharp & Dohme Corp (MVX MSD) Y
Completion Status CP Y
Route of Administration Intramuscular (NCIT IM)  
Administration Site Right Thigh (HL70163 RT)  
     

Notes to Testers

No Note


1.1.3. Enter Initial Immunization Data for Juana Mariana Gonzales from Another Practice

Test Step Type: SUT_MANUAL
Patient History from another practice is entered into the EMR.

Test Story

Description

The EHR vendor loads immunization history data from another practice into the record for Juana Mariana Gonzales.


Comments

No Comments


PreCondition

The EMR has recorded all of the pediatric demographic  in the record created for Juana Mariana Gonzales.


PostCondition

The immunization history from another practice is loaded into the record created for Juana Mariana Gonzales.


Test Objectives

Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.


Evaluation Criteria

Evaluation Criteria: Vendor successfully records all immunization history data from another practice as provided, with all required attributes indicated by [Y]:

Historical Vaccine from Another Practice - Dtap    
Entered BY Sandra Molina Y
Ordering Provider J. Rodriguez Y
Entering Organization Shoreline Pediatrics Y
Vaccine Event information source Historical information - from parent’s written record (NIP001 03) Y
Value/Text for Vaccine Type  DTaP Y
Date/Time of Start of Administration 8/31/2014 Y
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) Y
Administered Amount (of Vaccine) 0.5 Y
Administered Units (of Measure) mL Y
Administration Notes   Y
Administering Provider Linda Casera Y
Administered-at Location 4253 Standish Way, Stamford Connecticut 06903 Y
Lot Number D643QS8243 Y
Substance Expiration Date 9/1/2014 Y
Substance Manufacturer Name Sanofi Pasteur Inc (MVX PMC) Y
Completion Status CP Y
Route of Administration Intramuscular (NCIT IM) Y
Administration Site Left Deltoid (HL70163 LD) Y
     
Historical Vaccine from Another Practice - Polio    
Entered BY Sandra Molina Y
Ordering Provider J. Rodriguez Y
Entering Organization Shoreline Pediatrics Y
Vaccine Event information source Historical information - from parent’s written record (NIP001 03) Y
Value/Text for Vaccine Type  DTaP Y
Date/Time of Start of Administration 2/21/2011 Y
Vaccine Administered poliovirus vaccine, inactivated (CVX 10) Y
Administered Amount (of Vaccine) 0.5 Y
Administered Units (of Measure) mL Y
Administration Notes   Y
Administering Provider Linda Casera Y
Administered-at Location 4253 Standish Way, Stamford Connecticut 06903 Y
Lot Number D335PV9644 Y
Substance Expiration Date 2/22/2011 Y
Substance Manufacturer Name Sanofi Pasteur Inc (MVX PMC) Y
Completion Status CP Y
Route of Administration Intramuscular (NCIT IM) Y
Administration Site Left Deltoid (HL70163 LD) Y
Reaction VXC12^fever of >40.5C (105F) within 48 hours of dose^CDCPHINVS Y

Notes to Testers

No Note


1.1.4. Enter Initial Immunization Data for Juana Mariana Gonzales Reported by Parent

Test Step Type: SUT_MANUAL
Patient History from a pharmacy as reported by the parent is entered into the EMR.

Test Story

Description

The provider enters immunization data from a pharmacy as reported by the parent for Juana Mariana Gonzales.

 


Comments

No Comments


PreCondition

The EMR has recorded all of the pediatric demographic data  in the record created for Juana Mariana Gonzales.


PostCondition

The immunization history from the pharmacy as reported by the parent is loaded into the record created for Juana Mariana Gonzales.


Test Objectives

Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.


Evaluation Criteria

Evaluation Criteria: Vendor successfully records all immunization history data from the pharmacy as provided by the parent with all required attributes indicated by [Y]:

Historical Vaccine from Pharmacy Reported by Parent    
Entered BY Sandra Molina Y
Ordering Provider Gina Ricci Y
Entering Organization Shoreline Pediatrics Y
Vaccine Event information source Historical information - from other provider (NIP001 02) Y
Value/Text for Vaccine Type  Influenza vaccine Y
Date/Time of Start of Administration 10/15/2013 Y
Vaccine Administered influenza, live, intranasal, quadrivalent (CVX 149) FluMist Quadrivalent (NDC 66019-0301-10)) Y
Administered Amount (of Vaccine) 0.5 Y
Administered Units (of Measure) mL Y
Administration Notes   Y
Administering Provider Gina Ricci Y
Administered-at Location Oceanview Pharmacy, 15 Post Road, Stamford Connecticut 06901 Y
Lot Number 8L4B3423 Y
Substance Expiration Date 7/1/2014 Y
Substance Manufacturer Name MedImmune, LLC (MVX MED) Y
Completion Status CP Y
Route of Administration Nasal (NCIT NS) Y
Administration Site   Y

Notes to Testers

No Note


1.1.5. Enter Adverse Reaction to the Polio Vaccine

Test Step Type: SUT_MANUAL
The EHR captures structured data regarding adverse events as part of the clinical history.

Test Story

Description

The provider documents in the EMR the clinical history of an adverse reaction to the polio vaccine.


Comments

No Comments


PreCondition

The EMR has recorded all of the pediatric demographic in the record created for Juana Mariana Gonzales.


PostCondition

The clinical history of the adverse reaction to the Polio vaccine is documented in the the record created for Juana Mariana Gonzales.


Test Objectives

Identify Adverse Event: The EHR or other clinical software system enables capture of structured data regarding adverse events.


Evaluation Criteria

Evaluation Criteria: Vendor successfully records all demographic data provided with all required attributes indicated by [Y]:

Adverse Reaction Substance/Agent inactivated polio vaccine (e.g. Poliomyelitis vaccine adverse reaction (disorder) 293117006) Y
Reaction febrile seizure (e.g. Simple febrile seizure (finding) 432354000)
VXC11^convulsions (fits, seizures) within 72 hours of dose^
Y
Date (of the reaction) 8/31/2014 Y

Notes to Testers

No Note


1.1.6. Enter allergy to egg albumin

Test Step Type: SUT_MANUAL
The EHR captures structured data regarding allergies as part of the clinical history.

Test Story

Description

The provider documents in the EMR the clinical history of an allergy to egg albumin.


Comments

No Comments


PreCondition

The EMR has recorded all of the pediatric demographic in the record created for Juana Mariana Gonzales.


PostCondition

The clinical history of the allergy to egg albumin is documented in the record created for Juana Mariana Gonzales


Test Objectives

Supporting data for: Modify Antigen Recommendations Based on Allergy History: The system notifies the provider of any conflicts between recommended vaccines in the updated forecast and the patient’s active allergies. 


Evaluation Criteria

Evaluation Criteria: Vendor successfully records all clinical allergy data provided with all required attributes indicated by [Y]:

Allergy Sugstance/Agent Egg Albumin Allergy (e.g. 213020009 Egg protein allergy (disorder), Allergy to eggs (disorder) 91930004) Y
Date (allergy status known - e.g. thru testing or date of the allergy) 8/31/2014 Y

Notes to Testers

No Note


2. Query and Display Response

Querying the registry will consist of the vendor creating Z44 messages for each patient to be sent to the registry. The response will be processed as part of the ?Display, Reconcile, Import and Update Immunization Information? activity.

2.1. Patient Juana Mariana Gonzales

EMR Generates a Z44 query to the Immunization Registry to retrieve the Evaluated History and Forecast for Juana Mariana Gonzales.

Test Story

Description
Query the Registry for Juana Mariana Gonzales

Comments
No Comments

PreCondition
Juana Mariana Gonzales is entered as a patient in the EMR with complete Demographic data, Immunization History Data, and Clinical Data according to the steps in the 'Juana Mariana Gonzales Initial Data Load'

PostCondition
A Z44 Query is generated and submitted to the Immunization Registry/Test tool.

Test Objectives
Real Time Request/Receive Patient Immunization History: The system sends a request to the public health immunization registry ?on demand? (e.g., those without scheduled appointments). The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother?s maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Query Response Grammar (RSP) ? HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).

Evaluation Criteria
The vendor can produce a valid Z44 query in accordance with the test data correctly and without ommission.
The data in the message corresponds to the data in the EMR and contains all test data attributes supplied.

Notes to Testers
No Note

2.1.1. Select Patient Juana Mariana Gonzales

Test Step Type: SUT_MANUAL
Select patient Juana Mariana Gonzales, distinguishing the patient from other patients with similar demographics (similar names).

Test Story

Description

Juana Mariana Gonzales is selected as the patient and her record is opened in the EMR. 


Comments

No Comments


PreCondition

Juana Mariana Gonzales Initial Data Load completed.


PostCondition

Juana Mariana Gonzales is the active working patient in the EMR.


Test Objectives

Select New Patient: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information.  For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother’s maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient’s information to external systems such as an immunization registry.


Evaluation Criteria

Tester shall verify that the product can distinguish Juana Mariana Gonzales from similar sounding names using all of the pediatric demographics:

 

  • Patient ID (previously listed as “Medicaid Number”) - Vendor supplied
  • Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name - Shoreline Pediatrics 
  • Patient ID: Type (e.g., medical record number, IIS ID) - Vendor supplied
  • Patient Name: First - Juana 
  • Patient Name: Middle - Mariana 
  • Patient Date of Birth - 12/23/2009 
  • Birth Time - 11:05 
  • Patient Gender (Administrative Sex) - F
  • Patient Multiple Birth Indicator - No 
  • Patient Birth Order -  NA 
  • Responsible Person Name: First - Joanna 
  • Responsible Person Name: Middle - Merida 
  • Responsible Person Name: Last - Gonzales
  • Responsible Person Name: Relationship to Patient - Grandmother (or Grandparent) 
  • Mother’s Name: First - Maria 
  • Mother’s Name: Middle -Merida
  • Mother’s Name: Last - Gonzales
  • Mother’s Name: Maiden Last - Acosta 
  • Patient Address: Street - 4345 Standish Way 
  • Patient Address: City - Stamford
  • Patient Address: State - CT 
  • Patient Address: Country - US 
  • Patient Address: Zipcode - 06903 
  • Patient Address: County of Residence - Fairfield 
  • Race - Other 
  • Ethnicity - Hispanic or Latino 
  • Birthing Facility Name (Birth Delivery Location Address BDL) - Shoreline Hospital 325 Shorline Drive, Stamford Connecticut 06901 
  • Patient Birth State - CT
  • Patient Primary Language - English 
  • Patient Telephone Number - (203) 555-1212 
  • Patient Telephone Number Type (e.g., home, cell) - home 
  • Patient E-mail Address - jmg@gmail.com 
  • Publicity Code  
  • Protection Indicator 
  • Protection Indicator Effective Date 
  • Immunization Registry Status 
  • Preferred Contact Method - Phone  

Notes to Testers

No Note


2.1.2. Query Registry for vaccination history and forecast for Juana Mariana Gonzales

Test Step Type: SUT_INITIATOR
The EMR generates a Z44 query for immunization history and forecast correctly and without omission according to supplied test data.

Test Story

Description

The provider uses the EMR to query the Immunization Registry for an Evaluated History and Forecast based on information known to the Immunization Registry.


Comments

No Comments


PreCondition

Juana Mariana Gonzales Initial Data Load is completed.


PostCondition

The Immunization Registry responds with Evaluated Vaccine History and Forecast for Juana Mariana Gonzales


Test Objectives

Real Time Request/Receive Patient Immunization History: The system sends a request to the public health immunization registry “on demand” (e.g., those without scheduled appointments). The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother’s maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Query Response Grammar (RSP) – HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).


Evaluation Criteria
Tester shall verify that the vendor can produce a valid Z44 query in accordance with the test data correctly and without omission.
Tester shall verify that the data in the message corresponds to the data in the EMR and contains all test data attributes supplied.

Notes to Testers

No Note


Message Contents

MSH : Message Header
LocationData ElemenmtDataCategrization
MSH.1Field SeparatorFieldSeperator
MSH.2Encoding CharactersEncoding
MSH.3Sending Application
   MSH.3.1   Namespace ID
   MSH.3.2   Universal ID
   MSH.3.3   Universal ID Type
MSH.4Sending Facility
   MSH.4.1   Namespace ID
   MSH.4.2   Universal ID
   MSH.4.3   Universal ID Type
MSH.5Receiving Application
   MSH.5.1   Namespace ID
   MSH.5.2   Universal ID
   MSH.5.3   Universal ID Type
MSH.6Receiving Facility
   MSH.6.1   Namespace ID
   MSH.6.2   Universal ID
   MSH.6.3   Universal ID Type
MSH.7Date/Time Of Message
   MSH.7.1   Time20150615001020-0500
MSH.9Message Type
   MSH.9.1   Message CodeQBP
   MSH.9.2   Trigger EventQ11
   MSH.9.3   Message StructureQBP_Q11
MSH.10Message Control ID793543
MSH.11Processing ID
   MSH.11.1   Processing IDP
MSH.12Version ID
   MSH.12.1   Version ID2.5.1
MSH.15Accept Acknowledgment TypeER
MSH.16Application Acknowledgment TypeAL
MSH.21Message Profile Identifier
   MSH.21.1   Entity IdentifierZ44
   MSH.21.2   Namespace IDCDCPHINVS
   MSH.21.3   Universal ID
   MSH.21.4   Universal ID Type
MSH.22Sending Responsible Organization
   MSH.22.1   Organization Name
   MSH.22.6   Assigning Authority
      MSH.22.6.1      Namespace ID
      MSH.22.6.2      Universal ID
      MSH.22.6.3      Universal ID Type
   MSH.22.7   Identifier Type Code
   MSH.22.10   Organization Identifier
MSH.23Receiving Responsible Organization
   MSH.23.1   Organization Name
   MSH.23.6   Assigning Authority
      MSH.23.6.1      Namespace ID
      MSH.23.6.2      Universal ID
      MSH.23.6.3      Universal ID Type
   MSH.23.7   Identifier Type Code
   MSH.23.10   Organization Identifier

QPD : Query Parameter Definition
LocationData ElemenmtDataCategrization
QPD.1Message Query Name
   QPD.1.1   IdentifierZ44
   QPD.1.2   TextRequest Evaluated History and Forecast
   QPD.1.3   Name of Coding SystemCDCPHINVS
   QPD.1.5   Alternate Text
   QPD.1.6   Name of Alternate Coding System
QPD.2Query Tag37374859
QPD.3PatientList
   QPD.3.1   ID Number123456
   QPD.3.3   Check Digit Scheme
   QPD.3.4   Assigning Authority
      QPD.3.4.1      Namespace IDMYEHR
      QPD.3.4.2      Universal ID
      QPD.3.4.3      Universal ID Type
   QPD.3.5   Identifier Type CodeMR
QPD.4PatientName
   QPD.4.1   Family Name
      QPD.4.1.1      SurnameGonzalesTest Case Fixed
   QPD.4.2   Given NameJuanaTest Case Fixed
   QPD.4.3   Second and Further Given Names or Initials ThereofMarianaTest Case Fixed
   QPD.4.7   Name Type CodeLTest Case Fixed
QPD.5PatientMotherMaidenName
   QPD.5.1   Family Name
      QPD.5.1.1      SurnameAcostaTest Case Fixed
   QPD.5.7   Name Type CodeMTest Case Fixed
QPD.6PatientDateOfBirth
   QPD.6.1   Time200912231105Test Case Fixed
QPD.7Patient SexFTest Case Fixed
QPD.8Patient Address
   QPD.8.1   Street Address
      QPD.8.1.1      Street or Mailing Address4345 Standish Way
   QPD.8.2   Other DesignationTest Case Fixed
   QPD.8.3   CityStamfordTest Case Fixed
   QPD.8.4   State or ProvinceCTTest Case Fixed
   QPD.8.5   Zip or Postal Code06903Test Case Fixed
   QPD.8.6   Country
   QPD.8.7   Address TypeLTest Case Fixed
QPD.9Phone
   QPD.9.2   Telecommunication Use CodePRNTest Case Fixed
   QPD.9.3   Telecommunication Equipment TypePHTest Case Fixed
   QPD.9.4   Email Address
   QPD.9.6   Area/City Code203Test Case Fixed
   QPD.9.7   Local Number5551212Test Case Fixed
QPD.10Multiple birth indicator
QPD.11Birth order

RCP : Response Control Parameter
LocationData ElemenmtDataCategrization
RCP.1Query PriorityI

Test Data Specification

Patient Information
Element Data
Patient Name Juana Mariana Gonzales
Date/Time of Birth 12/23/2009
Sex F
Patient Address 4345 Standish Way Stamford CT
Patient Phone (203)555-1212

2.1.3. View and Compare response to request for vaccination history for Juana Mariana Gonzales

Test Step Type: TA_RESPONDER
The EMR displays the Immunization History results (Z42) returned in response to the Z44 Query and compare to those in the EMR.

Test Story

Description

The Immunization Registry returns an Evaluated History and Forecast (Z42) to the EMR in response to the query for patient (Juana Mariana Gonzales). The provider reviews the immunization history from the registry and compares to the immunization history in the EMR. The provider reconciles the information from these sources, importing information known only to the registry, retaining information that is more accurately reflected in the local EMR:

The physician accesses the record for Juana Mariana Gonzales and:
• Reconciles the EHR vaccine history with the history retrieved from the registry:
o Accepts new vaccines from the registry data
o If the EHR does not already flag the first MMRV as invalid, the provider updates the first MMRV to indicate it is “invalid” as it was given too early (as notified by the registry)
o Retains the local history for influenza and polio vaccines that are not included in the registry report.

Comments

No Comments


PreCondition

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR. 


PostCondition

Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juana Mariana Gonzales)


Test Objectives

Compare Public Health Immunization Registry (IIS) Immunization History to EHR Immunization History: The public health immunization registry has returned the requested immunization history for a patient. The EHR is able to display the immunization history received from the registry as well as the immunization history already present in the EHR so that a user can compare them.  The EHR provides a way for the provider to view both histories, determine what is different (if anything), and update the existing EHR immunization history with new information from the public health registry if he or she chooses to do so. The system must store the new information as structured data as part of the patient’s local immunization history and include the time of the update and the source of the new information.

 
Review Patient Immunization History: To assist with the ordering process, the EHR or other clinical software system allows a user to specify standard views of patient immunization information for each vaccine dose administration, including patient-specific data (e.g., age on dates of administration, etc.).

Evaluation Criteria

1. The EMR displays the information returned from the Immunization Registry according to the Juror Document. 

 

Notes to Testers

No Note


Message Contents

MSH : Message Header
LocationData ElemenmtDataCategrization
MSH.1Field SeparatorFieldSeperator
MSH.2Encoding CharactersEncoding
MSH.3Sending Application
   MSH.3.1   Namespace IDMYIIS
   MSH.3.2   Universal ID
   MSH.3.3   Universal ID Type
MSH.4Sending Facility
   MSH.4.1   Namespace IDMyStateIIS
   MSH.4.2   Universal ID
   MSH.4.3   Universal ID Type
MSH.5Receiving Application
   MSH.5.1   Namespace IDMYEHR
   MSH.5.2   Universal ID
   MSH.5.3   Universal ID Type
MSH.6Receiving Facility
   MSH.6.1   Namespace IDMyclinic
   MSH.6.2   Universal ID
   MSH.6.3   Universal ID Type
MSH.7Date/Time Of Message
   MSH.7.1   Time20091130020020-0500
MSH.9Message Type
   MSH.9.1   Message CodeRSP
   MSH.9.2   Trigger EventK11
   MSH.9.3   Message StructureRSP_K11
MSH.10Message Control ID7731029
MSH.11Processing ID
   MSH.11.1   Processing IDP
MSH.12Version ID
   MSH.12.1   Version ID2.5.1
MSH.15Accept Acknowledgment TypeNE
MSH.16Application Acknowledgment TypeNE
MSH.21Message Profile Identifier
   MSH.21.1   Entity IdentifierZ42
   MSH.21.2   Namespace IDCDCPHINVS
   MSH.21.3   Universal ID
   MSH.21.4   Universal ID Type
MSH.22Sending Responsible Organization
   MSH.22.1   Organization NameA_Clinic
   MSH.22.6   Assigning Authority
      MSH.22.6.1      Namespace IDX68
      MSH.22.6.2      Universal ID
      MSH.22.6.3      Universal ID Type
   MSH.22.7   Identifier Type CodeAN
   MSH.22.10   Organization IdentifierA_Clinic1234
MSH.23Receiving Responsible Organization
   MSH.23.1   Organization Name
   MSH.23.6   Assigning Authority
      MSH.23.6.1      Namespace ID
      MSH.23.6.2      Universal ID
      MSH.23.6.3      Universal ID Type
   MSH.23.7   Identifier Type Code
   MSH.23.10   Organization Identifier

MSA : Message Acknowledgment
LocationData ElemenmtDataCategrization
MSA.1Acknowledgment CodeAA
MSA.2Message Control ID793543

QAK : Query Acknowledgment
LocationData ElemenmtDataCategrization
QAK.1Query Tag37374859
QAK.2Query Response StatusOK
QAK.3Message Query Name
   QAK.3.1   IdentifierZ44
   QAK.3.2   TextRequest Evaluated History and Forecast
   QAK.3.3   Name of Coding SystemCDCPHINVS
   QAK.3.5   Alternate Text
   QAK.3.6   Name of Alternate Coding System

QPD : Query Parameter Definition
LocationData ElemenmtDataCategrization
QPD.1Message Query Name
   QPD.1.1   IdentifierZ44
   QPD.1.2   TextRequest Evaluated History and Forecast
   QPD.1.3   Name of Coding SystemCDCPHINVS
   QPD.1.5   Alternate Text
   QPD.1.6   Name of Alternate Coding System
QPD.2Query Tag37374859
QPD.3PatientList
   QPD.3.1   ID Number
   QPD.3.3   Check Digit Scheme
   QPD.3.4   Assigning Authority
      QPD.3.4.1      Namespace ID
      QPD.3.4.2      Universal ID
      QPD.3.4.3      Universal ID Type
   QPD.3.5   Identifier Type Code
QPD.4PatientName
   QPD.4.1   Family Name
      QPD.4.1.1      SurnameGonzales
   QPD.4.2   Given NameJuana
   QPD.4.3   Second and Further Given Names or Initials ThereofMariana
   QPD.4.7   Name Type CodeL
QPD.5PatientMotherMaidenName
   QPD.5.1   Family Name
      QPD.5.1.1      SurnameAcosta
   QPD.5.7   Name Type CodeM
QPD.6PatientDateOfBirth
   QPD.6.1   Time200912231105
QPD.7Patient SexF
QPD.8Patient Address
   QPD.8.1   Street Address
      QPD.8.1.1      Street or Mailing Address4345 Standish Way
   QPD.8.2   Other Designation
   QPD.8.3   CityStamford
   QPD.8.4   State or ProvinceCT
   QPD.8.5   Zip or Postal Code
   QPD.8.6   Country
   QPD.8.7   Address TypeL
QPD.9Phone
   QPD.9.2   Telecommunication Use CodePRN
   QPD.9.3   Telecommunication Equipment TypePH
   QPD.9.4   Email Address
   QPD.9.6   Area/City Code203
   QPD.9.7   Local Number5551212
QPD.10Multiple birth indicator
QPD.11Birth order

PID : Patient Identification
LocationData ElemenmtDataCategrization
PID.1Set ID - PID1
PID.3Patient Identifier List
   PID.3.1   ID Number123456
   PID.3.3   Check Digit Scheme
   PID.3.4   Assigning Authority
      PID.3.4.1      Namespace IDMYEHR
      PID.3.4.2      Universal ID
      PID.3.4.3      Universal ID Type
   PID.3.5   Identifier Type CodeMR
PID.3Patient Identifier List
   PID.3.1   ID Number987633
   PID.3.3   Check Digit Scheme
   PID.3.4   Assigning Authority
      PID.3.4.1      Namespace IDMYIIS
      PID.3.4.2      Universal ID
      PID.3.4.3      Universal ID Type
   PID.3.5   Identifier Type CodeSR
PID.5Patient Name
   PID.5.1   Family Name
      PID.5.1.1      SurnameGonzales
   PID.5.2   Given NameJuana
   PID.5.3   Second and Further Given Names or Initials ThereofMariana
   PID.5.7   Name Type CodeL
PID.7Date/Time of Birth
   PID.7.1   Time200912231105
PID.8Administrative SexF
PID.11Patient Address
   PID.11.1   Street Address
      PID.11.1.1      Street or Mailing Address4345 Standish Way
   PID.11.2   Other Designation
   PID.11.3   CityStamford
   PID.11.4   State or ProvinceCT
   PID.11.5   Zip or Postal Code06903
   PID.11.6   CountryUSA
   PID.11.7   Address TypeL
PID.30Patient Death Indicator

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20091123
RXA.5Administered Code
   RXA.5.1   Identifier08
   RXA.5.2   Texthepatitis B vaccine, pediatric or pediatric/adolescent dosage
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextENGERIX-B
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX1
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX3
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value1
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX4
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value3
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100115
RXA.5Administered Code
   RXA.5.1   Identifier45
   RXA.5.2   Texthepatitis B vaccine, unspecified formulation
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextENGERIX-B
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierRT
   RXR.2.2   TextRight Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX5
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX6
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX7
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value2
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX8
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value3
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20101030
RXA.5Administered Code
   RXA.5.1   Identifier08
   RXA.5.2   Texthepatitis B vaccine, pediatric or pediatric/adolescent dosage
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextENGERIX-B
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX9
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX10
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX11
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value3
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX12
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value3
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100122
RXA.5Administered Code
   RXA.5.1   Identifier107
   RXA.5.2   Textdiphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextDAPTACEL
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX13
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX14
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX15
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value1
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX16
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value5
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeTS
OBX.3Observation Identifier
   OBX.3.1   Identifier29768-9
   OBX.3.2   TextVIS Publication Date
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Time20070517
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20100122

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier29769-7
   OBX.3.2   TextVIS presented
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID2
OBX.5Observation Value20100122
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX3
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier69764-9
   OBX.3.2   TextDocument type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID2
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF<
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100323
RXA.5Administered Code
   RXA.5.1   Identifier106
   RXA.5.2   Textdiphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextDAPTACEL
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierRT
   RXR.2.2   TextRight Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX17
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX18
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX19
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value2
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX20
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value5
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeTS
OBX.3Observation Identifier
   OBX.3.1   Identifier29768-9
   OBX.3.2   TextVIS Publication Date
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Time20070517
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20100323

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier29769-7
   OBX.3.2   TextVIS presented
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID2
OBX.5Observation Value20100323
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX3
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier69764-9
   OBX.3.2   TextDocument type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID2
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF<
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100522
RXA.5Administered Code
   RXA.5.1   Identifier106
   RXA.5.2   Textdiphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextDAPTACEL
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX21
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier31044-1
   OBX.3.2   TextReaction
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20100523

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX22
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX23
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX24
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value3
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX25
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value5
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeTS
OBX.3Observation Identifier
   OBX.3.1   Identifier29768-9
   OBX.3.2   TextVIS Publication Date
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Time20070517
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20100522

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier29769-7
   OBX.3.2   TextVIS presented
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID2
OBX.5Observation Value20100522
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX3
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier69764-9
   OBX.3.2   TextDocument type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID2
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF<
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20110221
RXA.5Administered Code
   RXA.5.1   Identifier106
   RXA.5.2   Textdiphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextDAPTACEL
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX26
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX27
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX28
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX29
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value5
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeTS
OBX.3Observation Identifier
   OBX.3.1   Identifier29768-9
   OBX.3.2   TextVIS Publication Date
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Time20070517
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20110221

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier29769-7
   OBX.3.2   TextVIS presented
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID2
OBX.5Observation Value20110221
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX3
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier69764-9
   OBX.3.2   TextDocument type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID2
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF<
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100122
RXA.5Administered Code
   RXA.5.1   Identifier49
   RXA.5.2   TextHaemophilus influenzae type b vaccine, PRP-OMP conjugate
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextPedvaxHIB
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierRT
   RXR.2.2   TextRight Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX30
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX31
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX32
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value1
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX33
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100323
RXA.5Administered Code
   RXA.5.1   Identifier49
   RXA.5.2   TextHaemophilus influenzae type b vaccine, PRP-OMP conjugate
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextPedvaxHIB
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX34
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX35
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX36
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value2
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX37
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100522
RXA.5Administered Code
   RXA.5.1   Identifier49
   RXA.5.2   TextHaemophilus influenzae type b vaccine, PRP-OMP conjugate
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextPedvaxHIB
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierRT
   RXR.2.2   TextRight Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX38
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX39
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX40
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value3
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX41
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100221
RXA.5Administered Code
   RXA.5.1   Identifier49
   RXA.5.2   TextHaemophilus influenzae type b vaccine, PRP-OMP conjugate
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextPedvaxHIB
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX42
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX43
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX44
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX45
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100122
RXA.5Administered Code
   RXA.5.1   Identifier10
   RXA.5.2   Textpoliovirus vaccine, inactivated
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextIPOL
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC38299
   RXR.1.2   TextSC
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextSubcutaneous
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX46
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX47
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX48
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value1
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX49
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100323
RXA.5Administered Code
   RXA.5.1   Identifier10
   RXA.5.2   Textpoliovirus vaccine, inactivated
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextIPOL
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC38299
   RXR.1.2   TextSC
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextSubcutaneous
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX50
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX51
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX52
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value2
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX53
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100121
RXA.5Administered Code
   RXA.5.1   Identifier133
   RXA.5.2   Textpneumococcal conjugate vaccine, 13 valent
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextPREVNAR 13
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX54
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX55
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX56
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value3
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX57
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100323
RXA.5Administered Code
   RXA.5.1   Identifier133
   RXA.5.2   Textpneumococcal conjugate vaccine, 13 valent
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextPREVNAR 13
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX58
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX59
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX60
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX61
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100522
RXA.5Administered Code
   RXA.5.1   Identifier133
   RXA.5.2   Textpneumococcal conjugate vaccine, 13 valent
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextPREVNAR 13
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierRT
   RXR.2.2   TextRight Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX62
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX63
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX64
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value1
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX65
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20110221
RXA.5Administered Code
   RXA.5.1   Identifier133
   RXA.5.2   Textpneumococcal conjugate vaccine, 13 valent
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextPREVNAR 13
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX66
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX67
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX68
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value2
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX69
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100122
RXA.5Administered Code
   RXA.5.1   Identifier119
   RXA.5.2   Textrotavirus, live, monovalent vaccine
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextROTARIX
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX70
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX71
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX72
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value1
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX73
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value3
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100122
RXA.5Administered Code
   RXA.5.1   Identifier119
   RXA.5.2   Textrotavirus, live, monovalent vaccine
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextROTARIX
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierRT
   RXR.2.2   TextRight Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX74
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX75
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX76
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value1
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX77
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value3
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100925
RXA.5Administered Code
   RXA.5.1   Identifier161
   RXA.5.2   TextInfluenza, injectable,quadrivalent, preservative free, pediatric
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextFLUZONE QUADRIVALENT
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.25
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX78
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX79
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX80
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value1
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX81
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value2
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20101027
RXA.5Administered Code
   RXA.5.1   Identifier161
   RXA.5.2   TextInfluenza, injectable,quadrivalent, preservative free, pediatric
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextFLUZONE QUADRIVALENT
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.25
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierRT
   RXR.2.2   TextRight Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX82
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX83
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX84
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value2
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX85
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value2
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20111002
RXA.5Administered Code
   RXA.5.1   Identifier161
   RXA.5.2   TextInfluenza, injectable,quadrivalent, preservative free, pediatric
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextFLUZONE QUADRIVALENT
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount.25
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX86
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX87
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20120404
RXA.5Administered Code
   RXA.5.1   Identifier161
   RXA.5.2   TextInfluenza, injectable,quadrivalent, preservative free, pediatric
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextFLUZONE QUADRIVALENT
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.25
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX88
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX89
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20111123
RXA.5Administered Code
   RXA.5.1   Identifier83
   RXA.5.2   Texthepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextHAVRIX
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierRD
   RXR.2.2   TextRight Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX90
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX91
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX92
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value1
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX93
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value2
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeTS
OBX.3Observation Identifier
   OBX.3.1   Identifier29768-9
   OBX.3.2   TextVIS Publication Date
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Time20111025
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20111123

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier29769-7
   OBX.3.2   TextVIS presented
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID2
OBX.5Observation Value20111123
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX3
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier69764-9
   OBX.3.2   TextDocument type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID2
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF<
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20120523
RXA.5Administered Code
   RXA.5.1   Identifier83
   RXA.5.2   Texthepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextHAVRIX
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX94
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX95
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX96
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value2
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX97
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value2
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeTS
OBX.3Observation Identifier
   OBX.3.1   Identifier29768-9
   OBX.3.2   TextVIS Publication Date
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Time20111025
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20120523

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier29769-7
   OBX.3.2   TextVIS presented
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID2
OBX.5Observation Value20120523
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX3
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier69764-9
   OBX.3.2   TextDocument type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID2
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF<
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20101023
RXA.5Administered Code
   RXA.5.1   Identifier94
   RXA.5.2   Textmeasles, mumps, rubella, and varicella virus vaccine
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextProQuad
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMolina
   RXA.10.3   Given NameSandra
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC38299
   RXR.1.2   TextSubcutaneous
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextSubcutaneous
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX98
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX99
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueN
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX101
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30982-3
   OBX.3.2   TextReason code
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeTS
OBX.3Observation Identifier
   OBX.3.1   Identifier29768-9
   OBX.3.2   TextVIS Publication Date
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Time20100521
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20101023

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier29769-7
   OBX.3.2   TextVIS presented
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID2
OBX.5Observation Value20101023
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX3
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier69764-9
   OBX.3.2   TextDocument type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID2
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF<
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20121122
RXA.5Administered Code
   RXA.5.1   Identifier94
   RXA.5.2   Textmeasles, mumps, rubella, and varicella virus vaccine
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextProQuad
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC38299
   RXR.1.2   TextSubcutaneous
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextSubcutaneous
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX102
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX103
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX104
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value1
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX105
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value2
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeTS
OBX.3Observation Identifier
   OBX.3.1   Identifier29768-9
   OBX.3.2   TextVIS Publication Date
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Time20100521
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20121122

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier29769-7
   OBX.3.2   TextVIS presented
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID2
OBX.5Observation Value20121122
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX3
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier69764-9
   OBX.3.2   TextDocument type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID2
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF<
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20091031
RXA.5Administered Code
   RXA.5.1   Identifier998
   RXA.5.2   Textno vaccine admin
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate Text
   RXA.5.6   Name of Alternate Coding System
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier
   RXA.9.2   Text
   RXA.9.3   Name of Coding System
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      Surname
   RXA.10.3   Given Name
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace ID
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusNA

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX106
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX107
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX108
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier30980-7
   OBX.3.2   TextDate vaccination due
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20100522
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX108
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier30981-5
   OBX.3.2   TextEarliest date to give
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20100522
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX108
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier59777-3
   OBX.3.2   TextLatest date next dose may be given
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20110522
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX108
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier59778-1
   OBX.3.2   TextDate dose is overdue
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20110523
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX109
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20091031
RXA.5Administered Code
   RXA.5.1   Identifier998
   RXA.5.2   Textno vaccine admin
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate Text
   RXA.5.6   Name of Alternate Coding System
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier
   RXA.9.2   Text
   RXA.9.3   Name of Coding System
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      Surname
   RXA.10.3   Given Name
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace ID
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusNA

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX106
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX107
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX108
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier30980-7
   OBX.3.2   TextDate vaccination due
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20131122
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX108
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier30981-5
   OBX.3.2   TextEarliest date to give
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20131122
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX108
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier59777-3
   OBX.3.2   TextLatest date next dose may be given
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20151122
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX108
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier59778-1
   OBX.3.2   TextDate dose is overdue
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20151123
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX109
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX77
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20091031
RXA.5Administered Code
   RXA.5.1   Identifier998
   RXA.5.2   Textno vaccine admin
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate Text
   RXA.5.6   Name of Alternate Coding System
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier
   RXA.9.2   Text
   RXA.9.3   Name of Coding System
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      Surname
   RXA.10.3   Given Name
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace ID
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusNA

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX106
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX107
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX108
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier30981-5
   OBX.3.2   TextEarliest date to give
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20150901
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX108
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier30980-7
   OBX.3.2   TextDate vaccination due
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20150901
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX108
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier59777-3
   OBX.3.2   TextLatest date next dose may be given
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20160131
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX109
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX77
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20091031
RXA.5Administered Code
   RXA.5.1   Identifier998
   RXA.5.2   Textno vaccine admin
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate Text
   RXA.5.6   Name of Alternate Coding System
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier
   RXA.9.2   Text
   RXA.9.3   Name of Coding System
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      Surname
   RXA.10.3   Given Name
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace ID
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusNA

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX110
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID2
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX111
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX108
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier30981-5
   OBX.3.2   TextEarliest date to give
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20131122
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX112
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier30980-7
   OBX.3.2   TextDate vaccination due
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20131122
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX108
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier59777-3
   OBX.3.2   TextLatest date next dose may be given
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20151122
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX108
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier59778-1
   OBX.3.2   TextDate dose is overdue
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20151123
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX113
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value2
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX77
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value2
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20091031
RXA.5Administered Code
   RXA.5.1   Identifier998
   RXA.5.2   Textno vaccine admin
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate Text
   RXA.5.6   Name of Alternate Coding System
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier
   RXA.9.2   Text
   RXA.9.3   Name of Coding System
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      Surname
   RXA.10.3   Given Name
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace ID
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusNA

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX114
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX115
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX108
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier30981-5
   OBX.3.2   TextEarliest date to give
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20131122
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX112
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier30980-7
   OBX.3.2   TextDate vaccination due
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20131122
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX108
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier59777-3
   OBX.3.2   TextLatest date next dose may be given
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20151122
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX108
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier59778-1
   OBX.3.2   TextDate dose is overdue
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20151123
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX117
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value2
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX77
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value2
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

Juror Document

Evaluated Immunization History and Immunization Forecast (RSP Z42)
Test Case ID
Inspection Date/Time
Inspection Settlement
Pass Fail
Juror ID
Juror Name

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
Patient Identifier
ID Number 123456
Assigning Authority
Namespace ID MYEHR
ID Type MR
Patient Identifier
ID Number 987633
Assigning Authority
Namespace ID MYIIS
ID Type SR
Name Juana Mariana Gonzales
Date of Birth 12/23/2009
Sex Female
Address 1
Street 4345 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country USA
Address Type L
Mother's Maiden Name Maria Merida Acosta
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


Evaluated Immunization History Information
Entering Organization Oceanview Pediatrics
Vaccine Group Hep B Peds NOS
Vaccine Administered hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Refusal Reason
Date/Time Administration-Start 11/23/2009
Date/Time Administration-End 11/23/2009
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep B Peds NOS
Vaccine Administered hepatitis B vaccine, unspecified formulation
Refusal Reason
Date/Time Administration-Start 01/15/2010
Date/Time Administration-End 01/15/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep B Peds NOS
Vaccine Administered hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Refusal Reason
Date/Time Administration-Start 10/30/2010
Date/Time Administration-End 10/30/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Refusal Reason
Date/Time Administration-Start 01/22/2010
Date/Time Administration-End 01/22/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Refusal Reason
Date/Time Administration-Start 03/23/2010
Date/Time Administration-End 03/23/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Refusal Reason
Date/Time Administration-Start 05/22/2010
Date/Time Administration-End 05/22/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Refusal Reason
Date/Time Administration-Start 02/21/2011
Date/Time Administration-End 02/21/2011
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 01/22/2010
Date/Time Administration-End 01/22/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 03/23/2010
Date/Time Administration-End 03/23/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 05/22/2010
Date/Time Administration-End 05/22/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 02/21/2010
Date/Time Administration-End 02/21/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group poliovirus vaccine, inactivated
Vaccine Administered poliovirus vaccine, inactivated
Refusal Reason
Date/Time Administration-Start 01/22/2010
Date/Time Administration-End 01/22/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration SC
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group poliovirus vaccine, inactivated
Vaccine Administered poliovirus vaccine, inactivated
Refusal Reason
Date/Time Administration-Start 03/23/2010
Date/Time Administration-End 03/23/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration SC
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 01/21/2010
Date/Time Administration-End 01/21/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 03/23/2010
Date/Time Administration-End 03/23/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 05/22/2010
Date/Time Administration-End 05/22/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 02/21/2011
Date/Time Administration-End 02/21/2011
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group rotavirus, unspecified formulation
Vaccine Administered rotavirus, live, monovalent vaccine
Refusal Reason
Date/Time Administration-Start 01/22/2010
Date/Time Administration-End 01/22/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group rotavirus, unspecified formulation
Vaccine Administered rotavirus, live, monovalent vaccine
Refusal Reason
Date/Time Administration-Start 01/22/2010
Date/Time Administration-End 01/22/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric
Refusal Reason
Date/Time Administration-Start 09/25/2010
Date/Time Administration-End 09/25/2010
Administered Amount 0.25
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric
Refusal Reason
Date/Time Administration-Start 10/27/2010
Date/Time Administration-End 10/27/2010
Administered Amount 0.25
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric
Refusal Reason
Date/Time Administration-Start 10/02/2011
Date/Time Administration-End 10/02/2011
Administered Amount .25
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric
Refusal Reason
Date/Time Administration-Start 04/04/2012
Date/Time Administration-End 04/04/2012
Administered Amount 0.25
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep A, unspecified formulation
Vaccine Administered hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Refusal Reason
Date/Time Administration-Start 11/23/2011
Date/Time Administration-End 11/23/2011
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Deltoid
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep A, unspecified formulation
Vaccine Administered hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Refusal Reason
Date/Time Administration-Start 05/23/2012
Date/Time Administration-End 05/23/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Shoreline Pediatrics
Vaccine Group MMRV
Vaccine Administered measles, mumps, rubella, and varicella virus vaccine
Refusal Reason
Date/Time Administration-Start 10/23/2010
Date/Time Administration-End 10/23/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Subcutaneous
Administration Site Left Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name Sandra Molina
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 400 Shoreline Drive
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose NO
Validity Reason Early
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group MMRV
Vaccine Administered measles, mumps, rubella, and varicella virus vaccine
Refusal Reason
Date/Time Administration-Start 11/22/2012
Date/Time Administration-End 11/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Subcutaneous
Administration Site Left Deltoid
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".


Immunization Forecast
Vaccine Group IPV
Vaccine Due Date 05/22/2010
Earliest Date to Give 05/22/2010
Latest Date to Give 05/22/2011
Date When Vaccine Overdue 05/23/2011
Status in Immunization Series
Forecast Reason
 
Vaccine Group IPV
Vaccine Due Date 11/22/2013
Earliest Date to Give 11/22/2013
Latest Date to Give 11/22/2015
Date When Vaccine Overdue 11/23/2015
Status in Immunization Series
Forecast Reason
 
Vaccine Group influenza, unspecified formulation
Vaccine Due Date 09/01/2015
Earliest Date to Give 09/01/2015
Latest Date to Give 01/31/2016
Date When Vaccine Overdue 11/23/2015
Status in Immunization Series
Forecast Reason
 
Vaccine Group MMR
Vaccine Due Date 11/22/2013
Earliest Date to Give 11/22/2013
Latest Date to Give 11/22/2015
Date When Vaccine Overdue 11/23/2015
Status in Immunization Series
Forecast Reason
 
Vaccine Group Varicella
Vaccine Due Date 11/22/2013
Earliest Date to Give 11/22/2013
Latest Date to Give 11/22/2015
Date When Vaccine Overdue 11/23/2015
Status in Immunization Series
Forecast Reason
 

2.1.4. Mark first MMRV Dose as Invalid

Test Step Type: SUT_MANUAL
If the EHR does not already flag the first MMRV as invalid, the provider updates the first MMRV to indicate it is ?invalid? as it was given too early (as notified by the registry).

Test Story

Description

 If the EHR does not already flag the first MMRV as invalid, the provider updates the first MMRV to indicate it is “invalid” as it was given too early (as notified by the registry)


Comments

If the EMR already recognizes the dose as invalid, then this step may be skipped. 


PreCondition

MMRV status indicates that the first MMRV dose is valid.


PostCondition

MMRV status for the first MMRV dose administered on 10/23/2010 is set to invalid.


Test Objectives

dose validity is an important aspect of:

Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.

Evaluation Criteria

Vendor is able to record that the vaccination dose is invalid with a reason that it was given too early


Notes to Testers

No Note


2.1.5. View the vaccination forecast for Juana Mariana Gonzales

Test Step Type: SUT_MANUAL
Vendor can successfully display the current Immunization Forecast (vaccination names and recommended vaccination dates) as returned by the Registry (Z42).

Test Story

Description

The physician accesses the record for Juana Mariana Gonzales and:

• Displays the registry forecast which includes the need for a second, valid MMRV vaccine and also the need for influenza and polio vaccines (since the registry has no information about them)


Comments

No Comments


PreCondition

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR. 


PostCondition

Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juana Mariana Gonzales)


Test Objectives

View Immunization Forecast: The system provides a view of the immunization forecast provided by the public health immunization registry (IIS).  The display includes the forecast from the registry and includes recommended vaccination dates, minimum (earliest) date, ideal date, and maximum (latest) date for each vaccine included in the forecast.


Evaluation Criteria

1. The EMR displays the information returned from the Immunization Registry according to the Juror Document.

2. Verify that All forecast vaccines and dates returned by the registry are displayed to the user. 


Notes to Testers

No Note


Message Contents

MSH : Message Header
LocationData ElemenmtDataCategrization
MSH.1Field SeparatorFieldSeperator
MSH.2Encoding CharactersEncoding
MSH.3Sending Application
   MSH.3.1   Namespace IDMYIIS
   MSH.3.2   Universal ID
   MSH.3.3   Universal ID Type
MSH.4Sending Facility
   MSH.4.1   Namespace IDMyStateIIS
   MSH.4.2   Universal ID
   MSH.4.3   Universal ID Type
MSH.5Receiving Application
   MSH.5.1   Namespace IDMYEHR
   MSH.5.2   Universal ID
   MSH.5.3   Universal ID Type
MSH.6Receiving Facility
   MSH.6.1   Namespace IDMyclinic
   MSH.6.2   Universal ID
   MSH.6.3   Universal ID Type
MSH.7Date/Time Of Message
   MSH.7.1   Time20091130020020-0500
MSH.9Message Type
   MSH.9.1   Message CodeRSP
   MSH.9.2   Trigger EventK11
   MSH.9.3   Message StructureRSP_K11
MSH.10Message Control ID7731029
MSH.11Processing ID
   MSH.11.1   Processing IDP
MSH.12Version ID
   MSH.12.1   Version ID2.5.1
MSH.15Accept Acknowledgment TypeNE
MSH.16Application Acknowledgment TypeNE
MSH.21Message Profile Identifier
   MSH.21.1   Entity IdentifierZ42
   MSH.21.2   Namespace IDCDCPHINVS
   MSH.21.3   Universal ID
   MSH.21.4   Universal ID Type
MSH.22Sending Responsible Organization
   MSH.22.1   Organization NameA_Clinic
   MSH.22.6   Assigning Authority
      MSH.22.6.1      Namespace IDX68
      MSH.22.6.2      Universal ID
      MSH.22.6.3      Universal ID Type
   MSH.22.7   Identifier Type CodeAN
   MSH.22.10   Organization IdentifierA_Clinic1234
MSH.23Receiving Responsible Organization
   MSH.23.1   Organization Name
   MSH.23.6   Assigning Authority
      MSH.23.6.1      Namespace ID
      MSH.23.6.2      Universal ID
      MSH.23.6.3      Universal ID Type
   MSH.23.7   Identifier Type Code
   MSH.23.10   Organization Identifier

MSA : Message Acknowledgment
LocationData ElemenmtDataCategrization
MSA.1Acknowledgment CodeAA
MSA.2Message Control ID793543

QAK : Query Acknowledgment
LocationData ElemenmtDataCategrization
QAK.1Query Tag37374859
QAK.2Query Response StatusOK
QAK.3Message Query Name
   QAK.3.1   IdentifierZ44
   QAK.3.2   TextRequest Evaluated History and Forecast
   QAK.3.3   Name of Coding SystemCDCPHINVS
   QAK.3.5   Alternate Text
   QAK.3.6   Name of Alternate Coding System

QPD : Query Parameter Definition
LocationData ElemenmtDataCategrization
QPD.1Message Query Name
   QPD.1.1   IdentifierZ44
   QPD.1.2   TextRequest Evaluated History and Forecast
   QPD.1.3   Name of Coding SystemCDCPHINVS
   QPD.1.5   Alternate Text
   QPD.1.6   Name of Alternate Coding System
QPD.2Query Tag37374859
QPD.3PatientList
   QPD.3.1   ID Number
   QPD.3.3   Check Digit Scheme
   QPD.3.4   Assigning Authority
      QPD.3.4.1      Namespace ID
      QPD.3.4.2      Universal ID
      QPD.3.4.3      Universal ID Type
   QPD.3.5   Identifier Type Code
QPD.4PatientName
   QPD.4.1   Family Name
      QPD.4.1.1      SurnameGonzales
   QPD.4.2   Given NameJuana
   QPD.4.3   Second and Further Given Names or Initials ThereofMariana
   QPD.4.7   Name Type CodeL
QPD.5PatientMotherMaidenName
   QPD.5.1   Family Name
      QPD.5.1.1      SurnameAcosta
   QPD.5.7   Name Type CodeM
QPD.6PatientDateOfBirth
   QPD.6.1   Time200912231105
QPD.7Patient SexF
QPD.8Patient Address
   QPD.8.1   Street Address
      QPD.8.1.1      Street or Mailing Address4345 Standish Way
   QPD.8.2   Other Designation
   QPD.8.3   CityStamford
   QPD.8.4   State or ProvinceCT
   QPD.8.5   Zip or Postal Code
   QPD.8.6   Country
   QPD.8.7   Address TypeL
QPD.9Phone
   QPD.9.2   Telecommunication Use CodePRN
   QPD.9.3   Telecommunication Equipment TypePH
   QPD.9.4   Email Address
   QPD.9.6   Area/City Code203
   QPD.9.7   Local Number5551212
QPD.10Multiple birth indicator
QPD.11Birth order

PID : Patient Identification
LocationData ElemenmtDataCategrization
PID.1Set ID - PID1
PID.3Patient Identifier List
   PID.3.1   ID Number123456
   PID.3.3   Check Digit Scheme
   PID.3.4   Assigning Authority
      PID.3.4.1      Namespace IDMYEHR
      PID.3.4.2      Universal ID
      PID.3.4.3      Universal ID Type
   PID.3.5   Identifier Type CodeMR
PID.3Patient Identifier List
   PID.3.1   ID Number987633
   PID.3.3   Check Digit Scheme
   PID.3.4   Assigning Authority
      PID.3.4.1      Namespace IDMYIIS
      PID.3.4.2      Universal ID
      PID.3.4.3      Universal ID Type
   PID.3.5   Identifier Type CodeSR
PID.5Patient Name
   PID.5.1   Family Name
      PID.5.1.1      SurnameGonzales
   PID.5.2   Given NameJuana
   PID.5.3   Second and Further Given Names or Initials ThereofMariana
   PID.5.7   Name Type CodeL
PID.7Date/Time of Birth
   PID.7.1   Time200912231105
PID.8Administrative SexF
PID.11Patient Address
   PID.11.1   Street Address
      PID.11.1.1      Street or Mailing Address4345 Standish Way
   PID.11.2   Other Designation
   PID.11.3   CityStamford
   PID.11.4   State or ProvinceCT
   PID.11.5   Zip or Postal Code06903
   PID.11.6   CountryUSA
   PID.11.7   Address TypeL
PID.30Patient Death Indicator

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20091123
RXA.5Administered Code
   RXA.5.1   Identifier08
   RXA.5.2   Texthepatitis B vaccine, pediatric or pediatric/adolescent dosage
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextENGERIX-B
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX1
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Identifier31
   OBX.5.2   TextHep B Peds NOS
   OBX.5.3   Name of Coding SystemCVX
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
   OBX.5.1   IdentifierVXC16
   OBX.5.2   TextACIP
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX3
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value1
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX4
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value3
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100115
RXA.5Administered Code
   RXA.5.1   Identifier45
   RXA.5.2   Texthepatitis B vaccine, unspecified formulation
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextENGERIX-B
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierRT
   RXR.2.2   TextRight Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX5
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Identifier31
   OBX.5.2   TextHep B Peds NOS
   OBX.5.3   Name of Coding SystemCVX
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX6
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
   OBX.5.1   IdentifierVXC16
   OBX.5.2   TextACIP
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX7
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value2
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX8
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value3
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20101030
RXA.5Administered Code
   RXA.5.1   Identifier08
   RXA.5.2   Texthepatitis B vaccine, pediatric or pediatric/adolescent dosage
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextENGERIX-B
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX9
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Identifier31
   OBX.5.2   TextHep B Peds NOS
   OBX.5.3   Name of Coding SystemCVX
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX10
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
   OBX.5.1   IdentifierVXC16
   OBX.5.2   TextACIP
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX11
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value3
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX12
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value3
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100122
RXA.5Administered Code
   RXA.5.1   Identifier107
   RXA.5.2   Textdiphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextDAPTACEL
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX13
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Identifier107
   OBX.5.2   Textdiphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
   OBX.5.3   Name of Coding SystemCVX
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX14
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
   OBX.5.1   IdentifierVXC16
   OBX.5.2   TextACIP
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX15
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value1
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX16
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value5
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeTS
OBX.3Observation Identifier
   OBX.3.1   Identifier29768-9
   OBX.3.2   TextVIS Publication Date
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Time20070517
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20100122

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier29769-7
   OBX.3.2   TextVIS presented
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID2
OBX.5Observation Value20100122
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX3
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier69764-9
   OBX.3.2   TextDocument type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID2
OBX.5Observation Value
   OBX.5.1   Identifier253088698300003511070517
   OBX.5.2   TextDiphtheria/Tetanus/Pertussis (DTaP) VIS
   OBX.5.3   Name of Coding Systemcdcgs1vis
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF<
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100323
RXA.5Administered Code
   RXA.5.1   Identifier106
   RXA.5.2   Textdiphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextDAPTACEL
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierRT
   RXR.2.2   TextRight Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX17
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Identifier107
   OBX.5.2   Textdiphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
   OBX.5.3   Name of Coding SystemCVX
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX18
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
   OBX.5.1   IdentifierVXC16
   OBX.5.2   TextACIP
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX19
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value2
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX20
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value5
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeTS
OBX.3Observation Identifier
   OBX.3.1   Identifier29768-9
   OBX.3.2   TextVIS Publication Date
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Time20070517
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20100323

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier29769-7
   OBX.3.2   TextVIS presented
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID2
OBX.5Observation Value20100323
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX3
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier69764-9
   OBX.3.2   TextDocument type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID2
OBX.5Observation Value
   OBX.5.1   Identifier253088698300003511070517
   OBX.5.2   TextDiphtheria/Tetanus/Pertussis (DTaP) VIS
   OBX.5.3   Name of Coding Systemcdcgs1vis
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF<
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100522
RXA.5Administered Code
   RXA.5.1   Identifier106
   RXA.5.2   Textdiphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextDAPTACEL
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX21
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier31044-1
   OBX.3.2   TextReaction
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   IdentifierVXC12
   OBX.5.2   Textfever of >40.5C (105F) within 48 hours of dose
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20100523

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX22
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Identifier107
   OBX.5.2   Textdiphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
   OBX.5.3   Name of Coding SystemCVX
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX23
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
   OBX.5.1   IdentifierVXC16
   OBX.5.2   TextACIP
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX24
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value3
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX25
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value5
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeTS
OBX.3Observation Identifier
   OBX.3.1   Identifier29768-9
   OBX.3.2   TextVIS Publication Date
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Time20070517
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20100522

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier29769-7
   OBX.3.2   TextVIS presented
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID2
OBX.5Observation Value20100522
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX3
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier69764-9
   OBX.3.2   TextDocument type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID2
OBX.5Observation Value
   OBX.5.1   Identifier253088698300003511070517
   OBX.5.2   TextDiphtheria/Tetanus/Pertussis (DTaP) VIS
   OBX.5.3   Name of Coding Systemcdcgs1vis
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF<
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20110221
RXA.5Administered Code
   RXA.5.1   Identifier106
   RXA.5.2   Textdiphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextDAPTACEL
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX26
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Identifier107
   OBX.5.2   Textdiphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
   OBX.5.3   Name of Coding SystemCVX
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX27
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
   OBX.5.1   IdentifierVXC16
   OBX.5.2   TextACIP
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX28
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX29
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value5
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeTS
OBX.3Observation Identifier
   OBX.3.1   Identifier29768-9
   OBX.3.2   TextVIS Publication Date
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Time20070517
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20110221

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier29769-7
   OBX.3.2   TextVIS presented
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID2
OBX.5Observation Value20110221
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX3
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier69764-9
   OBX.3.2   TextDocument type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID2
OBX.5Observation Value
   OBX.5.1   Identifier253088698300003511070517
   OBX.5.2   TextDiphtheria/Tetanus/Pertussis (DTaP) VIS
   OBX.5.3   Name of Coding Systemcdcgs1vis
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF<
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100122
RXA.5Administered Code
   RXA.5.1   Identifier49
   RXA.5.2   TextHaemophilus influenzae type b vaccine, PRP-OMP conjugate
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextPedvaxHIB
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierRT
   RXR.2.2   TextRight Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX30
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Identifier17
   OBX.5.2   TextHib, unspecified formulation
   OBX.5.3   Name of Coding SystemCVX
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX31
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
   OBX.5.1   IdentifierVXC16
   OBX.5.2   TextACIP
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX32
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value1
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX33
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100323
RXA.5Administered Code
   RXA.5.1   Identifier49
   RXA.5.2   TextHaemophilus influenzae type b vaccine, PRP-OMP conjugate
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextPedvaxHIB
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX34
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Identifier17
   OBX.5.2   TextHib, unspecified formulation
   OBX.5.3   Name of Coding SystemCVX
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX35
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
   OBX.5.1   IdentifierVXC16
   OBX.5.2   TextACIP
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX36
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value2
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX37
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100522
RXA.5Administered Code
   RXA.5.1   Identifier49
   RXA.5.2   TextHaemophilus influenzae type b vaccine, PRP-OMP conjugate
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextPedvaxHIB
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierRT
   RXR.2.2   TextRight Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX38
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Identifier17
   OBX.5.2   TextHib, unspecified formulation
   OBX.5.3   Name of Coding SystemCVX
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX39
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
   OBX.5.1   IdentifierVXC16
   OBX.5.2   TextACIP
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX40
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value3
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX41
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100221
RXA.5Administered Code
   RXA.5.1   Identifier49
   RXA.5.2   TextHaemophilus influenzae type b vaccine, PRP-OMP conjugate
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextPedvaxHIB
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX42
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Identifier17
   OBX.5.2   TextHib, unspecified formulation
   OBX.5.3   Name of Coding SystemCVX
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX43
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
   OBX.5.1   IdentifierVXC16
   OBX.5.2   TextACIP
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX44
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX45
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100122
RXA.5Administered Code
   RXA.5.1   Identifier10
   RXA.5.2   Textpoliovirus vaccine, inactivated
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextIPOL
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC38299
   RXR.1.2   TextSC
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextSubcutaneous
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX46
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Identifier10
   OBX.5.2   Textpoliovirus vaccine, inactivated
   OBX.5.3   Name of Coding SystemCVX
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX47
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
   OBX.5.1   IdentifierVXC16
   OBX.5.2   TextACIP
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX48
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value1
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX49
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100323
RXA.5Administered Code
   RXA.5.1   Identifier10
   RXA.5.2   Textpoliovirus vaccine, inactivated
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextIPOL
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC38299
   RXR.1.2   TextSC
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextSubcutaneous
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX50
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Identifier10
   OBX.5.2   Textpoliovirus vaccine, inactivated
   OBX.5.3   Name of Coding SystemCVX
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX51
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
   OBX.5.1   IdentifierVXC16
   OBX.5.2   TextACIP
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX52
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value2
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX53
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100121
RXA.5Administered Code
   RXA.5.1   Identifier133
   RXA.5.2   Textpneumococcal conjugate vaccine, 13 valent
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextPREVNAR 13
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX54
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Identifier109
   OBX.5.2   Textpneumococcal, unspecified formulation
   OBX.5.3   Name of Coding SystemCVX
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX55
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
   OBX.5.1   IdentifierVXC16
   OBX.5.2   TextACIP
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX56
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value3
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX57
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100323
RXA.5Administered Code
   RXA.5.1   Identifier133
   RXA.5.2   Textpneumococcal conjugate vaccine, 13 valent
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextPREVNAR 13
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX58
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Identifier109
   OBX.5.2   Textpneumococcal, unspecified formulation
   OBX.5.3   Name of Coding SystemCVX
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX59
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
   OBX.5.1   IdentifierVXC16
   OBX.5.2   TextACIP
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX60
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX61
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100522
RXA.5Administered Code
   RXA.5.1   Identifier133
   RXA.5.2   Textpneumococcal conjugate vaccine, 13 valent
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextPREVNAR 13
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierRT
   RXR.2.2   TextRight Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX62
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Identifier109
   OBX.5.2   Textpneumococcal, unspecified formulation
   OBX.5.3   Name of Coding SystemCVX
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX63
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
   OBX.5.1   IdentifierVXC16
   OBX.5.2   TextACIP
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX64
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value1
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX65
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20110221
RXA.5Administered Code
   RXA.5.1   Identifier133
   RXA.5.2   Textpneumococcal conjugate vaccine, 13 valent
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextPREVNAR 13
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX66
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Identifier109
   OBX.5.2   Textpneumococcal, unspecified formulation
   OBX.5.3   Name of Coding SystemCVX
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX67
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
   OBX.5.1   IdentifierVXC16
   OBX.5.2   TextACIP
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX68
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value2
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX69
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100122
RXA.5Administered Code
   RXA.5.1   Identifier119
   RXA.5.2   Textrotavirus, live, monovalent vaccine
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextROTARIX
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX70
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Identifier122
   OBX.5.2   Textrotavirus, unspecified formulation
   OBX.5.3   Name of Coding SystemCVX
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX71
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
   OBX.5.1   IdentifierVXC16
   OBX.5.2   TextACIP
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX72
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value1
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX73
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value3
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100122
RXA.5Administered Code
   RXA.5.1   Identifier119
   RXA.5.2   Textrotavirus, live, monovalent vaccine
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextROTARIX
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierRT
   RXR.2.2   TextRight Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX74
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Identifier122
   OBX.5.2   Textrotavirus, unspecified formulation
   OBX.5.3   Name of Coding SystemCVX
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX75
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
   OBX.5.1   IdentifierVXC16
   OBX.5.2   TextACIP
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX76
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value1
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX77
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value3
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100925
RXA.5Administered Code
   RXA.5.1   Identifier161
   RXA.5.2   TextInfluenza, injectable,quadrivalent, preservative free, pediatric
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextFLUZONE QUADRIVALENT
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.25
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX78
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Identifier88
   OBX.5.2   Textinfluenza, unspecified formulation
   OBX.5.3   Name of Coding SystemCVX
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX79
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
   OBX.5.1   IdentifierVXC16
   OBX.5.2   TextACIP
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX80
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value1
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX81
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value2
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20101027
RXA.5Administered Code
   RXA.5.1   Identifier161
   RXA.5.2   TextInfluenza, injectable,quadrivalent, preservative free, pediatric
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextFLUZONE QUADRIVALENT
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.25
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierRT
   RXR.2.2   TextRight Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX82
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Identifier88
   OBX.5.2   Textinfluenza, unspecified formulation
   OBX.5.3   Name of Coding SystemCVX
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX83
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
   OBX.5.1   IdentifierVXC16
   OBX.5.2   TextACIP
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX84
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value2
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX85
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value2
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20111002
RXA.5Administered Code
   RXA.5.1   Identifier161
   RXA.5.2   TextInfluenza, injectable,quadrivalent, preservative free, pediatric
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextFLUZONE QUADRIVALENT
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount.25
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX86
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Identifier88
   OBX.5.2   Textinfluenza, unspecified formulation
   OBX.5.3   Name of Coding SystemCVX
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX87
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
   OBX.5.1   IdentifierVXC16
   OBX.5.2   TextACIP
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20120404
RXA.5Administered Code
   RXA.5.1   Identifier161
   RXA.5.2   TextInfluenza, injectable,quadrivalent, preservative free, pediatric
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextFLUZONE QUADRIVALENT
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.25
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX88
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Identifier88
   OBX.5.2   Textinfluenza, unspecified formulation
   OBX.5.3   Name of Coding SystemCVX
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX89
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
   OBX.5.1   IdentifierVXC16
   OBX.5.2   TextACIP
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20111123
RXA.5Administered Code
   RXA.5.1   Identifier83
   RXA.5.2   Texthepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextHAVRIX
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierRD
   RXR.2.2   TextRight Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX90
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Identifier85
   OBX.5.2   TextHep A, unspecified formulation
   OBX.5.3   Name of Coding SystemCVX
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX91
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
   OBX.5.1   IdentifierVXC16
   OBX.5.2   TextACIP
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX92
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value1
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX93
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value2
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeTS
OBX.3Observation Identifier
   OBX.3.1   Identifier29768-9
   OBX.3.2   TextVIS Publication Date
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Time20111025
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20111123

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier29769-7
   OBX.3.2   TextVIS presented
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID2
OBX.5Observation Value20111123
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX3
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier69764-9
   OBX.3.2   TextDocument type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID2
OBX.5Observation Value
   OBX.5.1   Identifier253088698300004211111025
   OBX.5.2   TextHepatitis A VIS
   OBX.5.3   Name of Coding Systemcdcgs1vis
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF<
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20120523
RXA.5Administered Code
   RXA.5.1   Identifier83
   RXA.5.2   Texthepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextHAVRIX
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX94
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Identifier85
   OBX.5.2   TextHep A, unspecified formulation
   OBX.5.3   Name of Coding SystemCVX
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX95
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
   OBX.5.1   IdentifierVXC16
   OBX.5.2   TextACIP
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX96
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value2
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX97
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value2
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeTS
OBX.3Observation Identifier
   OBX.3.1   Identifier29768-9
   OBX.3.2   TextVIS Publication Date
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Time20111025
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20120523

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier29769-7
   OBX.3.2   TextVIS presented
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID2
OBX.5Observation Value20120523
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX3
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier69764-9
   OBX.3.2   TextDocument type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID2
OBX.5Observation Value
   OBX.5.1   Identifier253088698300004211111025
   OBX.5.2   TextHepatitis A VIS
   OBX.5.3   Name of Coding Systemcdcgs1vis
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF<
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20101023
RXA.5Administered Code
   RXA.5.1   Identifier94
   RXA.5.2   Textmeasles, mumps, rubella, and varicella virus vaccine
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextProQuad
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMolina
   RXA.10.3   Given NameSandra
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC38299
   RXR.1.2   TextSubcutaneous
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextSubcutaneous
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX98
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Identifier94
   OBX.5.2   TextMMRV
   OBX.5.3   Name of Coding SystemCVX
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX99
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
   OBX.5.1   IdentifierVXC16
   OBX.5.2   TextACIP
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueN
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX101
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30982-3
   OBX.3.2   TextReason code
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
   OBX.5.1   Identifier264499004
   OBX.5.2   TextEarly
   OBX.5.3   Name of Coding SystemSCT
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeTS
OBX.3Observation Identifier
   OBX.3.1   Identifier29768-9
   OBX.3.2   TextVIS Publication Date
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Time20100521
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20101023

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier29769-7
   OBX.3.2   TextVIS presented
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID2
OBX.5Observation Value20101023
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX3
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier69764-9
   OBX.3.2   TextDocument type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID2
OBX.5Observation Value
   OBX.5.1   Identifier253088698300013411100521
   OBX.5.2   TextMeasles/Mumps/Rubella/Varicella VIS
   OBX.5.3   Name of Coding System
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF<
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20121122
RXA.5Administered Code
   RXA.5.1   Identifier94
   RXA.5.2   Textmeasles, mumps, rubella, and varicella virus vaccine
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextProQuad
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.5
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   Textnew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC38299
   RXR.1.2   TextSubcutaneous
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextSubcutaneous
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX102
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Identifier94
   OBX.5.2   TextMMRV
   OBX.5.3   Name of Coding SystemCVX
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX103
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value
   OBX.5.1   IdentifierVXC16
   OBX.5.2   TextACIP
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX104
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value1
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX105
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation Value2
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX100
OBX.2Value TypeID
OBX.3Observation Identifier
   OBX.3.1   Identifier59781-5
   OBX.3.2   TextDose validity
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID3
OBX.5Observation ValueY
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeTS
OBX.3Observation Identifier
   OBX.3.1   Identifier29768-9
   OBX.3.2   TextVIS Publication Date
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Time20100521
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20121122

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier29769-7
   OBX.3.2   TextVIS presented
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID2
OBX.5Observation Value20121122
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX3
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier69764-9
   OBX.3.2   TextDocument type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID2
OBX.5Observation Value
   OBX.5.1   Identifier253088698300013411100521
   OBX.5.2   TextMeasles/Mumps/Rubella/Varicella VIS
   OBX.5.3   Name of Coding System
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF<
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20091031
RXA.5Administered Code
   RXA.5.1   Identifier998
   RXA.5.2   Textno vaccine admin
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate Text
   RXA.5.6   Name of Alternate Coding System
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier
   RXA.9.2   Text
   RXA.9.3   Name of Coding System
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      Surname
   RXA.10.3   Given Name
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace ID
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusNA

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX106
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Identifier10
   OBX.5.2   TextIPV
   OBX.5.3   Name of Coding SystemCVX
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX107
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   IdentifierVXC16
   OBX.5.2   TextACIP
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX108
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier30980-7
   OBX.3.2   TextDate vaccination due
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20100522
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX108
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier30981-5
   OBX.3.2   TextEarliest date to give
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20100522
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX108
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier59777-3
   OBX.3.2   TextLatest date next dose may be given
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20110522
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX108
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier59778-1
   OBX.3.2   TextDate dose is overdue
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20110523
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX109
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20091031
RXA.5Administered Code
   RXA.5.1   Identifier998
   RXA.5.2   Textno vaccine admin
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate Text
   RXA.5.6   Name of Alternate Coding System
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier
   RXA.9.2   Text
   RXA.9.3   Name of Coding System
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      Surname
   RXA.10.3   Given Name
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace ID
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusNA

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX106
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Identifier10
   OBX.5.2   TextIPV
   OBX.5.3   Name of Coding SystemCVX
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX107
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   IdentifierVXC16
   OBX.5.2   TextACIP
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX108
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier30980-7
   OBX.3.2   TextDate vaccination due
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20131122
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX108
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier30981-5
   OBX.3.2   TextEarliest date to give
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20131122
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX108
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier59777-3
   OBX.3.2   TextLatest date next dose may be given
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20151122
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX108
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier59778-1
   OBX.3.2   TextDate dose is overdue
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20151123
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX109
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX77
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20091031
RXA.5Administered Code
   RXA.5.1   Identifier998
   RXA.5.2   Textno vaccine admin
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate Text
   RXA.5.6   Name of Alternate Coding System
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier
   RXA.9.2   Text
   RXA.9.3   Name of Coding System
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      Surname
   RXA.10.3   Given Name
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace ID
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusNA

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX106
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Identifier88
   OBX.5.2   Textinfluenza, unspecified formulation
   OBX.5.3   Name of Coding SystemCVX
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX107
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   IdentifierVXC16
   OBX.5.2   TextACIP
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX108
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier30981-5
   OBX.3.2   TextEarliest date to give
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20150901
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX108
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier30980-7
   OBX.3.2   TextDate vaccination due
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20150901
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX108
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier59777-3
   OBX.3.2   TextLatest date next dose may be given
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20160131
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX109
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX77
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value4
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20091031
RXA.5Administered Code
   RXA.5.1   Identifier998
   RXA.5.2   Textno vaccine admin
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate Text
   RXA.5.6   Name of Alternate Coding System
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier
   RXA.9.2   Text
   RXA.9.3   Name of Coding System
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      Surname
   RXA.10.3   Given Name
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace ID
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusNA

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX110
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID2
OBX.5Observation Value
   OBX.5.1   Identifier03
   OBX.5.2   TextMMR
   OBX.5.3   Name of Coding SystemCVX
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX111
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   IdentifierVXC16
   OBX.5.2   TextACIP
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX108
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier30981-5
   OBX.3.2   TextEarliest date to give
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20131122
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX112
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier30980-7
   OBX.3.2   TextDate vaccination due
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20131122
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX108
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier59777-3
   OBX.3.2   TextLatest date next dose may be given
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20151122
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX108
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier59778-1
   OBX.3.2   TextDate dose is overdue
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20151123
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX113
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value2
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX77
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value2
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20091031
RXA.5Administered Code
   RXA.5.1   Identifier998
   RXA.5.2   Textno vaccine admin
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate Text
   RXA.5.6   Name of Alternate Coding System
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier
   RXA.9.2   Text
   RXA.9.3   Name of Coding System
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      Surname
   RXA.10.3   Given Name
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace ID
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusNA

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX114
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier30956-7
   OBX.3.2   Textvaccine type
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Identifier21
   OBX.5.2   TextVaricella
   OBX.5.3   Name of Coding SystemCVX
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX115
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier59779-9
   OBX.3.2   TextImmunization Schedule used
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   IdentifierVXC16
   OBX.5.2   TextACIP
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX108
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier30981-5
   OBX.3.2   TextEarliest date to give
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20131122
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX112
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier30980-7
   OBX.3.2   TextDate vaccination due
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20131122
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX108
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier59777-3
   OBX.3.2   TextLatest date next dose may be given
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20151122
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX108
OBX.2Value TypeDT
OBX.3Observation Identifier
   OBX.3.1   Identifier59778-1
   OBX.3.2   TextDate dose is overdue
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value20151123
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX117
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier30973-2
   OBX.3.2   Textdose number in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value2
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20141216

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX77
OBX.2Value TypeNM
OBX.3Observation Identifier
   OBX.3.1   Identifier59782-3
   OBX.3.2   Textnumber of doses in series
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value2
OBX.6Units
   OBX.6.1   IdentifierNA
   OBX.6.2   Text
   OBX.6.3   Name of Coding SystemHL70353
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time

Juror Document

Evaluated Immunization History and Immunization Forecast (RSP Z42)
Test Case ID
Inspection Date/Time
Inspection Settlement
Pass Fail
Juror ID
Juror Name

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
Patient Identifier
ID Number 123456
Assigning Authority
Namespace ID MYEHR
ID Type MR
Patient Identifier
ID Number 987633
Assigning Authority
Namespace ID MYIIS
ID Type SR
Name Juana Mariana Gonzales
Date of Birth 12/23/2009
Sex Female
Address 1
Street 4345 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country USA
Address Type L
Mother's Maiden Name Maria Merida Acosta
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


Evaluated Immunization History Information
Entering Organization Oceanview Pediatrics
Vaccine Group Hep B Peds NOS
Vaccine Administered hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Refusal Reason
Date/Time Administration-Start 11/23/2009
Date/Time Administration-End 11/23/2009
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep B Peds NOS
Vaccine Administered hepatitis B vaccine, unspecified formulation
Refusal Reason
Date/Time Administration-Start 01/15/2010
Date/Time Administration-End 01/15/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep B Peds NOS
Vaccine Administered hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Refusal Reason
Date/Time Administration-Start 10/30/2010
Date/Time Administration-End 10/30/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Refusal Reason
Date/Time Administration-Start 01/22/2010
Date/Time Administration-End 01/22/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Refusal Reason
Date/Time Administration-Start 03/23/2010
Date/Time Administration-End 03/23/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Refusal Reason
Date/Time Administration-Start 05/22/2010
Date/Time Administration-End 05/22/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Refusal Reason
Date/Time Administration-Start 02/21/2011
Date/Time Administration-End 02/21/2011
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 01/22/2010
Date/Time Administration-End 01/22/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 03/23/2010
Date/Time Administration-End 03/23/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 05/22/2010
Date/Time Administration-End 05/22/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 02/21/2010
Date/Time Administration-End 02/21/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group poliovirus vaccine, inactivated
Vaccine Administered poliovirus vaccine, inactivated
Refusal Reason
Date/Time Administration-Start 01/22/2010
Date/Time Administration-End 01/22/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration SC
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group poliovirus vaccine, inactivated
Vaccine Administered poliovirus vaccine, inactivated
Refusal Reason
Date/Time Administration-Start 03/23/2010
Date/Time Administration-End 03/23/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration SC
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 01/21/2010
Date/Time Administration-End 01/21/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 03/23/2010
Date/Time Administration-End 03/23/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 05/22/2010
Date/Time Administration-End 05/22/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 02/21/2011
Date/Time Administration-End 02/21/2011
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group rotavirus, unspecified formulation
Vaccine Administered rotavirus, live, monovalent vaccine
Refusal Reason
Date/Time Administration-Start 01/22/2010
Date/Time Administration-End 01/22/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group rotavirus, unspecified formulation
Vaccine Administered rotavirus, live, monovalent vaccine
Refusal Reason
Date/Time Administration-Start 01/22/2010
Date/Time Administration-End 01/22/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric
Refusal Reason
Date/Time Administration-Start 09/25/2010
Date/Time Administration-End 09/25/2010
Administered Amount 0.25
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric
Refusal Reason
Date/Time Administration-Start 10/27/2010
Date/Time Administration-End 10/27/2010
Administered Amount 0.25
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric
Refusal Reason
Date/Time Administration-Start 10/02/2011
Date/Time Administration-End 10/02/2011
Administered Amount .25
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric
Refusal Reason
Date/Time Administration-Start 04/04/2012
Date/Time Administration-End 04/04/2012
Administered Amount 0.25
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep A, unspecified formulation
Vaccine Administered hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Refusal Reason
Date/Time Administration-Start 11/23/2011
Date/Time Administration-End 11/23/2011
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Deltoid
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep A, unspecified formulation
Vaccine Administered hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Refusal Reason
Date/Time Administration-Start 05/23/2012
Date/Time Administration-End 05/23/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Shoreline Pediatrics
Vaccine Group MMRV
Vaccine Administered measles, mumps, rubella, and varicella virus vaccine
Refusal Reason
Date/Time Administration-Start 10/23/2010
Date/Time Administration-End 10/23/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Subcutaneous
Administration Site Left Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name Sandra Molina
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 400 Shoreline Drive
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose NO
Validity Reason Early
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group MMRV
Vaccine Administered measles, mumps, rubella, and varicella virus vaccine
Refusal Reason
Date/Time Administration-Start 11/22/2012
Date/Time Administration-End 11/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Subcutaneous
Administration Site Left Deltoid
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".


Immunization Forecast
Vaccine Group IPV
Vaccine Due Date 05/22/2010
Earliest Date to Give 05/22/2010
Latest Date to Give 05/22/2011
Date When Vaccine Overdue 05/23/2011
Status in Immunization Series
Forecast Reason
 
Vaccine Group IPV
Vaccine Due Date 11/22/2013
Earliest Date to Give 11/22/2013
Latest Date to Give 11/22/2015
Date When Vaccine Overdue 11/23/2015
Status in Immunization Series
Forecast Reason
 
Vaccine Group influenza, unspecified formulation
Vaccine Due Date 09/01/2015
Earliest Date to Give 09/01/2015
Latest Date to Give 01/31/2016
Date When Vaccine Overdue 11/23/2015
Status in Immunization Series
Forecast Reason
 
Vaccine Group MMR
Vaccine Due Date 11/22/2013
Earliest Date to Give 11/22/2013
Latest Date to Give 11/22/2015
Date When Vaccine Overdue 11/23/2015
Status in Immunization Series
Forecast Reason
 
Vaccine Group Varicella
Vaccine Due Date 11/22/2013
Earliest Date to Give 11/22/2013
Latest Date to Give 11/22/2015
Date When Vaccine Overdue 11/23/2015
Status in Immunization Series
Forecast Reason
 

2.1.6. Reconcile and import vaccinations from Evaluated History and Forecast for Juana Mariana Gonzales

Test Step Type: SUT_MANUAL
The Provider uses the EMR to compare the immunization history results (Z42) returned by the Immunization Registry in response to the Z44 Query with the immunization history in the local system, and reconcile (import/update) records.

Test Story

Description

No Description


Comments

No Comments


PreCondition

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR.and  the response is available in the EMR for reconciliation and import. 


PostCondition

Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juana Mariana Gonzales)


Test Objectives

Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software is able to store immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered manually as patient-reported, and which were accepted electronically from the public health registry.


Evaluation Criteria
1. The user imports returned vaccinations as follows:
a. Vaccinations NOT imported:
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)  administered 1/15/2010
measles, mumps, rubella, and varicella virus vaccine (CVX 94) administered 11/22/2012
VERIFY that the dose validity is marked as invalid 
b. Vaccinations Imported:
 
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)  administered 10/30/2010
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 1/22/2010
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 3/23/2010,
Including adverse reaction 31044-1 Reaction, VXC12^fever of >40.5C (105F) within 48 hours of dose
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 5/22/2010
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 2/21/2011
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 1/22/2010
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 3/23/2010
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 5/22/2010
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 2/21/2011
poliovirus vaccine, inactivated (CVX 10) administered 1/22/2010
poliovirus vaccine, inactivated (CVX 10) administered 3/23/2010
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 1/22/2010
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 3/23/2010
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 5/22/2010
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 2/21/2011
rotavirus, live, monovalent vaccine (CVX 119) administered 3/23/2010
Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 9/25/2010
Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 10/27/2010
Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 10/2/2011
Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 11/4/2012
hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83) administered 11/23/2011
hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83) administered 5/23/2012
measles, mumps, rubella, and varicella virus vaccine (CVX 94) administered 11/22/2012
 

Notes to Testers

No Note


2.1.7. View the updated vaccination forecast for Juana Mariana Gonzales

Test Step Type: SUT_MANUAL
Using the reconciled vaccine history information, the EMR displays the current Immunization Forecast to the user for Juana Mariana Gonzales.

Test Story

Description

Once the vaccine history is reconciled in the EMR, the vaccine forecast is updated. 


Comments

No Comments


PreCondition

EMR Vaccine History is Reconciled with Immunization History from the IIS (previous step 'Reconcile and import vaccinations from Evaluated History and Forecast returned by the Registry for Juana Mariana Gonzales').


PostCondition

An updated vaccine forecast based upon the reconciled vaccine history is available to the user. 


Test Objectives

View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient’s newly updated immunization history, where the updated forecast results from the reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service.


Evaluation Criteria

Tester verifies that the vendor can display the immunization forecast based upon the reconciled vaccination history:

1. Verify that the EMR does not include in reconciled vaccine forecast:
IPV due on 5/22/2010
2. Verify that the EMR includes in reconciled vaccine forecast:
IPV due on 11/22/2013
MMR due on 5/22/2011
Varicella due on 5/22/2011
influenza, unspecified formulation due on 10/21/2015
 

Notes to Testers

No Note


3. Order and Immunize patient

This test will consist of ordering vaccines for the test patients, reviewing any alerts caused by specific scenarios, and documenting vaccinations administered to the patients. NOTE: There are no orders or immunizations in this test plan for Juana Maria Gonzales.

3.1. Juana Mariana Gonzales, Enter Orders and Immunizations

Orders and Immunization events, non-administrations, and alerts presented for current visit.

Test Story

Description
No Description

Comments
No Comments

PreCondition
No PreCondition

PostCondition
No PostCondition

Test Objectives
No Test Objectives

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

3.1.1. Order IPV and view prior reaction

Test Step Type: SUT_MANUAL
The provider selects to order IPV and views information about the prior febrile seizure post-IPV vaccine.

Test Story

Description

The physician accesses the record for Juana Mariana Gonzales and:

• Selects order for IPV and views information about the prior febrile seizure post-IPV vaccine


Comments

No Comments


PreCondition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR.


PostCondition

IPV order entered in patient record. User notified of history of adverse reaction to IPV (febrile seizures).


Test Objectives

Notify of Previous Adverse Event: EHRs and other clinical software systems alert providers to previous adverse events for a specific patient, in order to inform clinical decision-making when providers view an existing immunization record.


Evaluation Criteria

EMR Records the following order information and Alert:

Entered BY:                                       Sandra Molina

Ordering Provider:                               Frank Smith
Entering Organization:                        Shoreline Pediatrics
Vaccine Event information source:        New immunization record (NIP001 00) 
Vaccine Type:                                     IPV (CVX 10)
Date/Time Order was recorded:     Current Date
Alert:                                                 Alerts user to information about the prior febrile seizure post-IPV vaccine


Notes to Testers

No Note


3.1.2. IPV Parental Refusal

Test Step Type: SUT_MANUAL
Documents mother?s refusal for IPV vaccine indicating the parent decision, the reason and makes it permanent.

Test Story

Description

The mother is concerned about administering the IPV due to the prior adverse reaction, and refuses to have the child immunized for IPV. The provider documents mother’s refusal for IPV vaccine indicating the parent decision, the reason and makes it permanent.


Comments

No Comments


PreCondition

Prior Immunization History loaded and reconciled from the Immunization Registry. Order is attempted for IPV. Provider has been alerted to prior adverse reaction to IPV of febrile seizures.


PostCondition

Vaccine non-administration due to parental refusal is documented in the patient record. Deferral is permanent.


Test Objectives

Record Vaccine Administration Deferral: The EHR or other clinical software system allows a user to enter a reason or reasons why a specific immunization was not given to a patient (e.g., due to contraindication, refusal, etc.).  The system also stores that information in a structured way so it can be reported and analyzed as needed.


Evaluation Criteria

EMR documents the non-administration of the IPV due to the parental refulsal:

Substance/Treatment Refusal Reason:        Parental decision (NIP002 00)
Completion Status:                                    RE
Date/Time Vaccine Deferral was recorded:   Current Date
Deferral Reason:                                        Parental decision (NIP002 00)
Deferral Status:                                         Permanent
 


Notes to Testers

No Note


3.1.3. Record MMRV Vaccine administration

Test Step Type: SUT_MANUAL
The provider documents in the EMR all attributes associated with the new vaccine administration.

Test Story

Description

 

 

The nurse administers the the MMRV vaccine
• Documents all required information for each vaccine

 

 


Comments

No Comments


PreCondition

Order is placed for MMRV vaccine.


PostCondition

The MMRV vaccination is recorded in the EMR.


Test Objectives

Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered.  The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, site of administration (e.g., left arm), immunization type, product, lot number, manufacturer, Vaccine Information Statement date, and quantity of vaccine/dose size.


Evaluation Criteria

EMR Records the following vaccine administration information:

Entered BY:                                 Sandra Molina [Y]

Ordering Provider:                         Frank Smith  [Y]
Entering Organization:                   Shoreline Pediatrics [Y]
Vaccine Event information source:  New immunization record (NIP001 00) [Y] 
   (also known as administration notes)
Vaccine Type: measles, mumps, rubella, and varicella virus vaccine (CVX 94 ), [Y]
Date/Time of Start of Administration:    Current Date [Y]
Vaccine Administered: measles, mumps, rubella, and varicella virus vaccine (CVX 94 ), ProQuad (NDC 00006-4999-00) [Y]
Dose Number:             2
Doses in Series:          2
Administered Amount (of Vaccine):    0.5 [Y]
Administered Units (of Measure):      mL [Y]
Administering Provider:                    Sandra Molina [Y]
Administered-at Location:                400 Shoreline Drive, Stamford Connecticut 06901 [Y]
Lot Number:                                   7W87V3687 [Y]
Substance Expiration Date:             8/15/2015 [Y]
Substance Manufacturer Name:       Merck Sharp & Dohme Corp (MVX MSD) [Y]
Completion Status:                        CP [Y]
Route of Administration:                 Subcutaneous (NCIT C38299, HL70162: SC) [Y]
Administration Site:                        Left Deltoid (HL70162 LD)
 


Notes to Testers

No Note


4. Transmit Immunization Report

This test will consist of generating a Vaccine Update (VXU-Z22) report to the registry for three of the test patients, including updates for vaccines not given. NOTE: There is no Immunization Report in this test plan for Juana Maria Gonzales.

4.1. Juana Mariana Gonzales Transmit Immunization Report

Send the Immunization Report to the Immunization Registry (VXU/Z22) for Juana Mariana Gonzales.

Test Story

Description
Following the vaccinations given during the visit, the EMR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines. The report should include vaccines incorrectly recorded in the IIS. The report MAY send the immunizations that the EMR imported from the IIS.

Comments
The Report must include all newly administered vaccines in any order. the report may also include the corrected information where the EMR has different information than the IIS, and may also include the information imported from the IIS.

PreCondition
The vaccines for the visit have been administered.

PostCondition
No PostCondition

Test Objectives
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

4.1.1. Transmit the immunization report to the Immunization Registry

Test Step Type: TA_INITIATOR
The EMR send the Immunization Report to the Immunization Registry (VXU/Z22) for updated vaccination information from the visit. This includes all newly administered vaccines and may include historical information updated in the EMR during the visit.

Test Story

Description

Following the vaccinations given during the visit, the EMR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines. The report should include vaccines incorrectly recorded in the IIS. The report MAY send the immunizations that the EMR imported from the IIS.


Comments

The Report must include all newly administered vaccines in any order. the report may also include the corrected information where the EMR has different information than the IIS, and may also include the information imported from the IIS.


PreCondition

The vaccines for the visit have been administered.


PostCondition

The Immunization Report has been transmitted to the IIS using a valid Z22 VXU in accordance with the test data correctly and without omission.


Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.


Evaluation Criteria

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.


Notes to Testers

No Note


Message Contents

MSH : Message Header
LocationData ElemenmtDataCategrization
MSH.1Field SeparatorFieldSeperator
MSH.2Encoding CharactersEncoding
MSH.3Sending Application
   MSH.3.1   Namespace IDTest EHR Application
   MSH.3.2   Universal ID
   MSH.3.3   Universal ID Type
MSH.4Sending Facility
   MSH.4.1   Namespace IDX68
   MSH.4.2   Universal ID
   MSH.4.3   Universal ID Type
MSH.5Receiving Application
   MSH.5.1   Namespace ID
   MSH.5.2   Universal ID
   MSH.5.3   Universal ID Type
MSH.6Receiving Facility
   MSH.6.1   Namespace IDNIST Test Iz Reg
   MSH.6.2   Universal ID
   MSH.6.3   Universal ID Type
MSH.7Date/Time Of Message
   MSH.7.1   Time20120701082240-0500
MSH.9Message Type
   MSH.9.1   Message CodeVXU
   MSH.9.2   Trigger EventV04
   MSH.9.3   Message StructureVXU_V04
MSH.10Message Control IDNIST-IZ-001.01
MSH.11Processing ID
   MSH.11.1   Processing IDP
MSH.12Version ID
   MSH.12.1   Version ID2.5.1
MSH.15Accept Acknowledgment TypeER
MSH.16Application Acknowledgment TypeAL
MSH.21Message Profile Identifier
   MSH.21.1   Entity IdentifierZ22
   MSH.21.2   Namespace IDCDCPHINVS
   MSH.21.3   Universal ID
   MSH.21.4   Universal ID Type
MSH.22Sending Responsible Organization
   MSH.22.1   Organization Name
   MSH.22.6   Assigning Authority
      MSH.22.6.1      Namespace ID
      MSH.22.6.2      Universal ID
      MSH.22.6.3      Universal ID Type
   MSH.22.7   Identifier Type Code
   MSH.22.10   Organization Identifier
MSH.23Receiving Responsible Organization
   MSH.23.1   Organization Name
   MSH.23.6   Assigning Authority
      MSH.23.6.1      Namespace ID
      MSH.23.6.2      Universal ID
      MSH.23.6.3      Universal ID Type
   MSH.23.7   Identifier Type Code
   MSH.23.10   Organization Identifier

PID : Patient Identification
LocationData ElemenmtDataCategrization
PID.1Set ID - PID1
PID.3Patient Identifier List
   PID.3.1   ID Number123456
   PID.3.3   Check Digit Scheme
   PID.3.4   Assigning Authority
      PID.3.4.1      Namespace IDMYEHR
      PID.3.4.2      Universal ID
      PID.3.4.3      Universal ID Type
   PID.3.5   Identifier Type CodeMR
PID.3Patient Identifier List
   PID.3.1   ID Number987633
   PID.3.3   Check Digit Scheme
   PID.3.4   Assigning Authority
      PID.3.4.1      Namespace IDMYIIS
      PID.3.4.2      Universal ID
      PID.3.4.3      Universal ID Type
   PID.3.5   Identifier Type CodeSR
PID.5Patient Name
   PID.5.1   Family Name
      PID.5.1.1      SurnameGonzalesTest Case Fixed
   PID.5.2   Given NameJuanaTest Case Fixed
   PID.5.3   Second and Further Given Names or Initials ThereofMarianaTest Case Fixed
   PID.5.7   Name Type CodeLTest Case Fixed
PID.6Mother's Maiden Name
   PID.6.1   Family Name
      PID.6.1.1      SurnameAcostaTest Case Fixed
   PID.6.7   Name Type CodeMTest Case Fixed
PID.7Date/Time of Birth
   PID.7.1   Time200912231105Test Case Fixed
PID.8Administrative SexFTest Case Fixed
PID.10Race
   PID.10.1   Identifier2131-1Test Case Fixed
   PID.10.2   TextOther RaceTest Case Fixed
   PID.10.3   Name of Coding SystemHL70005Test Case Fixed
   PID.10.5   Alternate Text
   PID.10.6   Name of Alternate Coding System
PID.11Patient Address
   PID.11.1   Street Address
      PID.11.1.1      Street or Mailing Address4345 Standish WayTest Case Fixed
   PID.11.2   Other Designation
   PID.11.3   CityStamfordTest Case Fixed
   PID.11.4   State or ProvinceCTTest Case Fixed
   PID.11.5   Zip or Postal Code06903Test Case Fixed
   PID.11.6   CountryUSATest Case Fixed
   PID.11.7   Address TypeLTest Case Fixed
PID.11Patient Address
   PID.11.1   Street Address
      PID.11.1.1      Street or Mailing Address325 Shorline Drive
   PID.11.2   Other Designation
   PID.11.3   CityStamford
   PID.11.4   State or ProvinceCTTest Case Fixed
   PID.11.5   Zip or Postal Code06901
   PID.11.6   Country
   PID.11.7   Address TypeBDLTest Case Fixed
PID.13Phone Number - Home
   PID.13.2   Telecommunication Use CodePRNTest Case Fixed
   PID.13.3   Telecommunication Equipment TypePHTest Case Fixed
   PID.13.4   Email Address
   PID.13.6   Area/City Code203Test Case Fixed
   PID.13.7   Local Number5551212Test Case Fixed
PID.22Ethnic Group
   PID.22.1   Identifier2135-2Test Case Fixed
   PID.22.2   TextHispanic or LatinoTest Case Fixed
   PID.22.3   Name of Coding SystemCDCRECTest Case Fixed
   PID.22.5   Alternate Text
   PID.22.6   Name of Alternate Coding System
PID.24Multiple Birth Indicator
PID.25Birth Order
PID.29Patient Death Date and Time
   PID.29.1   Time
PID.30Patient Death Indicator

PD1 : Patient Additional Demographic
LocationData ElemenmtDataCategrization
PD1.11Publicity Code
   PD1.11.1   Identifier02
   PD1.11.2   TextReminder/Recall - any method
   PD1.11.3   Name of Coding SystemHL70215
   PD1.11.5   Alternate Text
   PD1.11.6   Name of Alternate Coding System
PD1.12Protection Indicator
PD1.13Protection Indicator Effective Date
PD1.16Immunization Registry StatusA
PD1.17Immunization Registry Status Effective Date20120701
PD1.18Publicity Code Effective Date20120701

NK1 : Next of Kin / Associated Parties
LocationData ElemenmtDataCategrization
NK1.1Set ID - NK11
NK1.2Name
   NK1.2.1   Family Name
      NK1.2.1.1      SurnameGonzales
   NK1.2.2   Given NameJoannaTest Case Fixed
   NK1.2.3   Second and Further Given Names or Initials ThereofMeridaTest Case Fixed
   NK1.2.7   Name Type CodeLTest Case Fixed
NK1.3Relationship
   NK1.3.1   IdentifierGRPTest Case Fixed
   NK1.3.2   TextGrandparentTest Case Fixed
   NK1.3.3   Name of Coding SystemHL70063Test Case Fixed
   NK1.3.5   Alternate Text
   NK1.3.6   Name of Alternate Coding System
NK1.4Address
   NK1.4.1   Street Address
      NK1.4.1.1      Street or Mailing Address4345 Standish WayTest Case Fixed
   NK1.4.2   Other Designation
   NK1.4.3   CityStamfordTest Case Fixed
   NK1.4.4   State or ProvinceCTTest Case Fixed
   NK1.4.5   Zip or Postal Code06901Test Case Fixed
   NK1.4.6   Country
   NK1.4.7   Address TypeLTest Case Fixed
NK1.5Phone Number
   NK1.5.2   Telecommunication Use CodePRNTest Case Fixed
   NK1.5.3   Telecommunication Equipment TypePHTest Case Fixed
   NK1.5.4   Email Address
   NK1.5.6   Area/City Code203Test Case Fixed
   NK1.5.7   Local Number5551212 Test Case Fixed

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameSirtis
   ORC.10.3   Given NameLisa
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameCarter
   ORC.12.3   Given NameJane
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierSH
   ORC.17.2   TextShoreline Hospital
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20091123
RXA.5Administered Code
   RXA.5.1   Identifier08
   RXA.5.2   Texthepatitis B vaccine, pediatric or pediatric/adolescent dosage
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextENGERIX-B
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameSirtis
   RXA.10.3   Given NameLisa
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot Number6332FK33
RXA.16Substance Expiration Date
   RXA.16.1   Time20101214
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierSKB
   RXA.17.2   TextGlaxoSmithKline Biologicals SA
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMolina
   ORC.10.3   Given NameSandra
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameSmith
   ORC.12.3   Given NameFrank
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierSP
   ORC.17.2   TextShoreline Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100115
RXA.5Administered Code
   RXA.5.1   Identifier45
   RXA.5.2   Texthepatitis B vaccine, unspecified formulation
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextENGERIX-B
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier01
   RXA.9.2   TextHistorical Immunization
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMolina
   RXA.10.3   Given NameSandra
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot Number6352FK1
RXA.16Substance Expiration Date
   RXA.16.1   Time20101001
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierSKB
   RXA.17.2   TextGlaxoSmithKline Biologicals SA
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierRT
   RXR.2.2   TextRight Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20101030
RXA.5Administered Code
   RXA.5.1   Identifier08
   RXA.5.2   Texthepatitis B vaccine, pediatric or pediatric/adolescent dosage
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextENGERIX-B
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot Number6352FK24
RXA.16Substance Expiration Date
   RXA.16.1   Time20120831
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierSKB
   RXA.17.2   TextGlaxoSmithKline Biologicals SA
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100122
RXA.5Administered Code
   RXA.5.1   Identifier107
   RXA.5.2   Textdiphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextDAPTACEL
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot NumberD409QS2341
RXA.16Substance Expiration Date
   RXA.16.1   Time20111130
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierPMC
   RXA.17.2   TextSanofi Pasteur Inc
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100323
RXA.5Administered Code
   RXA.5.1   Identifier106
   RXA.5.2   Textdiphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextDAPTACEL
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot NumberD409QS2433
RXA.16Substance Expiration Date
   RXA.16.1   Time20110904
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierPMC
   RXA.17.2   TextSanofi Pasteur Inc
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierRT
   RXR.2.2   TextRight Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeLTest Case Fixed
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100522
RXA.5Administered Code
   RXA.5.1   Identifier106
   RXA.5.2   Textdiphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextDAPTACEL
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot NumberD409QS3255
RXA.16Substance Expiration Date
   RXA.16.1   Time20101201
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierPMC
   RXA.17.2   TextSanofi Pasteur Inc
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX21
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier31044-1
   OBX.3.2   TextReaction
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   IdentifierVXC12
   OBX.5.2   Textfever of >40.5C (105F) within 48 hours of dose
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20100522
OBX.17Observation Method
   OBX.17.1   Identifier
   OBX.17.2   Text
   OBX.17.3   Name of Coding System
   OBX.17.5   Alternate Text
   OBX.17.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20110221
RXA.5Administered Code
   RXA.5.1   Identifier106
   RXA.5.2   Textdiphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextDAPTACEL
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot NumberD409QS249
RXA.16Substance Expiration Date
   RXA.16.1   Time20110301
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierPMC
   RXA.17.2   TextSanofi Pasteur Inc
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMolina
   ORC.10.3   Given NameSandra
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameRodriguez
   ORC.12.3   Given NameJ
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierSP
   ORC.17.2   TextShoreline Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20140831
RXA.5Administered Code
   RXA.5.1   Identifier106
   RXA.5.2   Textdiphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextDAPTACEL
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier02
   RXA.9.2   TextHistorical information - from other provider
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameCasera
   RXA.10.3   Given NameLinda
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot NumberD643QS8243
RXA.16Substance Expiration Date
   RXA.16.1   Time20140901
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierPMC
   RXA.17.2   TextSanofi Pasteur Inc
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100122
RXA.5Administered Code
   RXA.5.1   Identifier49
   RXA.5.2   TextHaemophilus influenzae type b vaccine, PRP-OMP conjugate
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextPedvaxHIB
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot Number7M54K9245
RXA.16Substance Expiration Date
   RXA.16.1   Time20100324
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierMSD
   RXA.17.2   TextMerck Sharp \T\ Dohme Corp
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierRT
   RXR.2.2   TextRight Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100323
RXA.5Administered Code
   RXA.5.1   Identifier49
   RXA.5.2   TextHaemophilus influenzae type b vaccine, PRP-OMP conjugate
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextPedvaxHIB
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot Number7M55K3342
RXA.16Substance Expiration Date
   RXA.16.1   Time20101030
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierMSD
   RXA.17.2   TextMerck Sharp \T\ Dohme Corp
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100522
RXA.5Administered Code
   RXA.5.1   Identifier49
   RXA.5.2   TextHaemophilus influenzae type b vaccine, PRP-OMP conjugate
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextPedvaxHIB
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot Number7M75K4566
RXA.16Substance Expiration Date
   RXA.16.1   Time20100523
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierMSD
   RXA.17.2   TextMerck Sharp \T\ Dohme Corp
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierRT
   RXR.2.2   TextRight Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20110221
RXA.5Administered Code
   RXA.5.1   Identifier49
   RXA.5.2   TextHaemophilus influenzae type b vaccine, PRP-OMP conjugate
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextPedvaxHIB
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot Number7M53K5534
RXA.16Substance Expiration Date
   RXA.16.1   Time20110222
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierMSD
   RXA.17.2   TextMerck Sharp \T\ Dohme Corp
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100122
RXA.5Administered Code
   RXA.5.1   Identifier10
   RXA.5.2   Textpoliovirus vaccine, inactivated
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextIPOL
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot NumberD333PV2431
RXA.16Substance Expiration Date
   RXA.16.1   Time20101004
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierPMC
   RXA.17.2   TextSanofi Pasteur Inc
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC38299
   RXR.1.2   TextSC
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextSubcutaneous
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100323
RXA.5Administered Code
   RXA.5.1   Identifier10
   RXA.5.2   Textpoliovirus vaccine, inactivated
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextIPOL
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot NumberD333PV4344
RXA.16Substance Expiration Date
   RXA.16.1   Time20100323
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierPMC
   RXA.17.2   TextSanofi Pasteur Inc
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC38299
   RXR.1.2   TextSC
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextSubcutaneous
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMolina
   ORC.10.3   Given NameSandra
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameRodriguez
   ORC.12.3   Given NameJ
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierSP
   ORC.17.2   TextShoreline Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20110221
RXA.5Administered Code
   RXA.5.1   Identifier10
   RXA.5.2   Textpoliovirus vaccine, inactivated
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextIPOL
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier02
   RXA.9.2   TextHistorical information - from other provider
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameCasera
   RXA.10.3   Given NameLinda
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot NumberD335PV9644
RXA.16Substance Expiration Date
   RXA.16.1   Time20110222
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierPMC
   RXA.17.2   TextSanofi Pasteur Inc
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC38299
   RXR.1.2   TextSC
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextSubcutaneous
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier9999
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMolina
   ORC.10.3   Given NameSandra
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameSmith
   ORC.12.3   Given NameFrank
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierSP
   ORC.17.2   TextShoreline Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20150519
RXA.5Administered Code
   RXA.5.1   Identifier10
   RXA.5.2   Textpoliovirus vaccine, inactivated
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate Text
   RXA.5.6   Name of Alternate Coding System
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier
   RXA.9.2   Text
   RXA.9.3   Name of Coding System
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      Surname
   RXA.10.3   Given Name
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace ID
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot Number
RXA.16Substance Expiration Date
   RXA.16.1   Time
RXA.17Substance Manufacturer Name
   RXA.17.1   Identifier
   RXA.17.2   Text
   RXA.17.3   Name of Coding System
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier00
   RXA.18.2   TextParental decision
   RXA.18.3   Name of Coding SystemNIP002
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusRE
RXA.21Action Code - RXAA

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100121
RXA.5Administered Code
   RXA.5.1   Identifier133
   RXA.5.2   Textpneumococcal conjugate vaccine, 13 valent
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextPREVNAR 13
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot NumberP243V3281
RXA.16Substance Expiration Date
   RXA.16.1   Time20100130
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierPFR
   RXA.17.2   TextPfizer, Inc
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100323
RXA.5Administered Code
   RXA.5.1   Identifier133
   RXA.5.2   Textpneumococcal conjugate vaccine, 13 valent
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextPREVNAR 13
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot NumberP343V8321
RXA.16Substance Expiration Date
   RXA.16.1   Time20100330
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierPFR
   RXA.17.2   TextPfizer, Inc
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC38299
   RXR.1.2   TextSC
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextSubcutaneous
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100522
RXA.5Administered Code
   RXA.5.1   Identifier133
   RXA.5.2   Textpneumococcal conjugate vaccine, 13 valent
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextPREVNAR 13
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot NumberP853V2164
RXA.16Substance Expiration Date
   RXA.16.1   Time20100830
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierPFR
   RXA.17.2   TextPfizer, Inc
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierRT
   RXR.2.2   TextRight Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20110221
RXA.5Administered Code
   RXA.5.1   Identifier133
   RXA.5.2   Textpneumococcal conjugate vaccine, 13 valent
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextPREVNAR 13
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot NumberP853V58532
RXA.16Substance Expiration Date
   RXA.16.1   Time20110418
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierPFR
   RXA.17.2   TextPfizer, Inc
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100122
RXA.5Administered Code
   RXA.5.1   Identifier119
   RXA.5.2   Textrotavirus, live, monovalent vaccine
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextROTARIX
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot Number6359RV533
RXA.16Substance Expiration Date
   RXA.16.1   Time20100215
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierSKB
   RXA.17.2   TextGlaxoSmithKline Biologicals SA
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100323
RXA.5Administered Code
   RXA.5.1   Identifier119
   RXA.5.2   Textrotavirus, live, monovalent vaccine
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextROTARIX
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot Number6359RV932
RXA.16Substance Expiration Date
   RXA.16.1   Time20100510
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierSKB
   RXA.17.2   TextGlaxoSmithKline Biologicals SA
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierRT
   RXR.2.2   TextRight Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100925
RXA.5Administered Code
   RXA.5.1   Identifier161
   RXA.5.2   TextInfluenza, injectable,quadrivalent, preservative free, pediatric
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextFLUZONE QUADRIVALENT
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot NumberD8043IN8734
RXA.16Substance Expiration Date
   RXA.16.1   Time20110312
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierPMC
   RXA.17.2   TextSanofi PasteurGlaxoSmithKline Biologicals SA
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20101027
RXA.5Administered Code
   RXA.5.1   Identifier161
   RXA.5.2   TextInfluenza, injectable,quadrivalent, preservative free, pediatric
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextFLUZONE QUADRIVALENT
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot NumberD8043IN8734
RXA.16Substance Expiration Date
   RXA.16.1   Time20110312
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierPMC
   RXA.17.2   TextSanofi PasteurGlaxoSmithKline Biologicals SA
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierRT
   RXR.2.2   TextRight Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20111002
RXA.5Administered Code
   RXA.5.1   Identifier161
   RXA.5.2   TextInfluenza, injectable,quadrivalent, preservative free, pediatric
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextFLUZONE QUADRIVALENT
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot NumberD9334IN9333
RXA.16Substance Expiration Date
   RXA.16.1   Time20120522
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierPMC
   RXA.17.2   TextSanofi PasteurGlaxoSmithKline Biologicals SA
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMolina
   ORC.10.3   Given NameSandra
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameRicci
   ORC.12.3   Given NameGina
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierSP
   ORC.17.2   TextShoreline Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20131015
RXA.5Administered Code
   RXA.5.1   Identifier161
   RXA.5.2   TextInfluenza, injectable,quadrivalent, preservative free, pediatric
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextFLUZONE QUADRIVALENT
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier03
   RXA.9.2   TextHistorical information - from parents written record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameRicci
   RXA.10.3   Given NameGina
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot Number8L4B3423
RXA.16Substance Expiration Date
   RXA.16.1   Time20140701
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierMED
   RXA.17.2   TextMedImmune, LLC
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC38284
   RXR.1.2   TextNasal
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextNasal
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierBN
   RXR.2.2   TextBilateral Nares
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMolinaTest Case Fixed
   ORC.10.3   Given NameSandraTest Case Fixed
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameSmithTest Case Fixed
   ORC.12.3   Given NameFrankTest Case Fixed
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeLTest Case Fixed
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierSP
   ORC.17.2   TextShoreline PediatricsTest Case Fixed
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20150715
RXA.5Administered Code
   RXA.5.1   Identifier149Test Case Fixed
   RXA.5.2   Textinfluenza, live, intranasal, quadrivalentTest Case Fixed
   RXA.5.3   Name of Coding SystemCVXTest Case Fixed
   RXA.5.5   Alternate TextFluMist QuadrivalentTest Case Fixed
   RXA.5.6   Name of Alternate Coding SystemNDCTest Case Fixed
RXA.6Administered Amount0.2Test Case Fixed
RXA.7Administered Units
   RXA.7.1   IdentifiermLTest Case Fixed
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUMTest Case Fixed
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00Test Case Fixed
   RXA.9.2   TextNew immunization recordTest Case Fixed
   RXA.9.3   Name of Coding SystemNIP001Test Case Fixed
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMolinaTest Case Fixed
   RXA.10.3   Given NameSandraTest Case Fixed
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot Number8L4B3521Test Case Fixed
RXA.16Substance Expiration Date
   RXA.16.1   Time20150815Test Case Fixed
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierMEDTest Case Fixed
   RXA.17.2   TextMedImmune,LLCTest Case Fixed
   RXA.17.3   Name of Coding SystemMVXTest Case Fixed
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCPTest Case Fixed
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC38284Test Case Fixed
   RXR.1.2   TextNasalTest Case Fixed
   RXR.1.3   Name of Coding SystemNCITTest Case Fixed
   RXR.1.5   Alternate TextNasalTest Case Fixed
   RXR.1.6   Name of Alternate Coding SystemHL70162Test Case Fixed
RXR.2Administration Site
   RXR.2.1   IdentifierBN
   RXR.2.2   TextBilateral Nares
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeTS
OBX.3Observation Identifier
   OBX.3.1   Identifier29768-9Test Case Fixed
   OBX.3.2   TextVIS Publication DateTest Case Fixed
   OBX.3.3   Name of Coding SystemLNTest Case Fixed
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Time20140819
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20150715
OBX.17Observation Method
   OBX.17.1   Identifier
   OBX.17.2   Text
   OBX.17.3   Name of Coding System
   OBX.17.5   Alternate Text
   OBX.17.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX3
OBX.2Value TypeTS
OBX.3Observation Identifier
   OBX.3.1   Identifier29769-7Test Case Fixed
   OBX.3.2   TextVIS Presentation DateTest Case Fixed
   OBX.3.3   Name of Coding SystemLNTest Case Fixed
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Time20150715
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20150715
OBX.17Observation Method
   OBX.17.1   Identifier
   OBX.17.2   Text
   OBX.17.3   Name of Coding System
   OBX.17.5   Alternate Text
   OBX.17.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX1
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier64994-7Test Case Fixed
   OBX.3.2   Textvaccine fund pgm elig catTest Case Fixed
   OBX.3.3   Name of Coding SystemLNTest Case Fixed
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   IdentifierV01
   OBX.5.2   TextNot VFC elig
   OBX.5.3   Name of Coding SystemHL70064
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20150715
OBX.17Observation Method
   OBX.17.1   Identifier
   OBX.17.2   Text
   OBX.17.3   Name of Coding System
   OBX.17.5   Alternate Text
   OBX.17.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20121104
RXA.5Administered Code
   RXA.5.1   Identifier149
   RXA.5.2   Textinfluenza, live, intranasal, quadrivalent
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextFluMist Quadrivalent
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot NumberD9553IN2243
RXA.16Substance Expiration Date
   RXA.16.1   Time20120430
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierPMC
   RXA.17.2   TextSanofi PasteurGlaxoSmithKline Biologicals SA
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20111123
RXA.5Administered Code
   RXA.5.1   Identifier83
   RXA.5.2   Texthepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextHAVRIX
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot Number6359RT33
RXA.16Substance Expiration Date
   RXA.16.1   Time20120124
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierSKB
   RXA.17.2   TextGlaxoSmithKline Biologicals SA
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierRD
   RXR.2.2   TextRight Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameSmith
   ORC.12.3   Given NameF
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20120523
RXA.5Administered Code
   RXA.5.1   Identifier83
   RXA.5.2   Texthepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextHAVRIX
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot Number6359RT48
RXA.16Substance Expiration Date
   RXA.16.1   Time20120911
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierPMC
   RXA.17.2   TextSanofi PasteurGlaxoSmithKline Biologicals SA
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameSmith
   ORC.12.3   Given NameF
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20101023
RXA.5Administered Code
   RXA.5.1   Identifier94
   RXA.5.2   Textmeasles, mumps, rubella, and varicella virus vaccine
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextProQuad
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier01
   RXA.9.2   Texthistorical
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot Number7W27V7491
RXA.16Substance Expiration Date
   RXA.16.1   Time20101215
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierMSD
   RXA.17.2   TextMerck Sharp \T\ Dohme Corp
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC38299
   RXR.1.2   TextSubcutaneous
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextSubcutaneous
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameSmith
   ORC.12.3   Given NameF
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20121122
RXA.5Administered Code
   RXA.5.1   Identifier94
   RXA.5.2   Textmeasles, mumps, rubella, and varicella virus vaccine
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextProQuad
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot Number7W87V3452
RXA.16Substance Expiration Date
   RXA.16.1   Time20130413
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierMSD
   RXA.17.2   TextMerck Sharp \T\ Dohme Corp
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC38299
   RXR.1.2   TextSubcutaneous
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextSubcutaneous
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMolinaTest Case Fixed
   ORC.10.3   Given NameSandraTest Case Fixed
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameSmithTest Case Fixed
   ORC.12.3   Given NameFrankTest Case Fixed
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeLTest Case Fixed
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierSP
   ORC.17.2   TextShoreline PediatricsTest Case Fixed
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20150715
RXA.5Administered Code
   RXA.5.1   Identifier94Test Case Fixed
   RXA.5.2   Textmeasles, mumps, rubella, and varicella virus vaccineTest Case Fixed
   RXA.5.3   Name of Coding SystemCVXTest Case Fixed
   RXA.5.5   Alternate TextProQuadTest Case Fixed
   RXA.5.6   Name of Alternate Coding SystemNDCTest Case Fixed
RXA.6Administered Amount0.5Test Case Fixed
RXA.7Administered Units
   RXA.7.1   IdentifiermLTest Case Fixed
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUMTest Case Fixed
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00Test Case Fixed
   RXA.9.2   TextNew immunization recordTest Case Fixed
   RXA.9.3   Name of Coding SystemNIP001Test Case Fixed
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMolinaTest Case Fixed
   RXA.10.3   Given NameSandraTest Case Fixed
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot Number7W87V3687Test Case Fixed
RXA.16Substance Expiration Date
   RXA.16.1   Time20150715Test Case Fixed
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierMSDTest Case Fixed
   RXA.17.2   TextMerck Sharp \T\ Dohme CorpTest Case Fixed
   RXA.17.3   Name of Coding SystemMVXTest Case Fixed
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCPTest Case Fixed
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC38299Test Case Fixed
   RXR.1.2   TextSubcutaneousTest Case Fixed
   RXR.1.3   Name of Coding SystemNCITTest Case Fixed
   RXR.1.5   Alternate TextSubcutaneousTest Case Fixed
   RXR.1.6   Name of Alternate Coding SystemHL70162Test Case Fixed
RXR.2Administration Site
   RXR.2.1   IdentifierLDTest Case Fixed
   RXR.2.2   TextLeft DeltoidTest Case Fixed
   RXR.2.3   Name of Coding SystemHL70163 Test Case Fixed
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeTS
OBX.3Observation Identifier
   OBX.3.1   Identifier29768-9Test Case Fixed
   OBX.3.2   TextVIS Publication DateTest Case Fixed
   OBX.3.3   Name of Coding SystemLNTest Case Fixed
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Time20100521
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20150715
OBX.17Observation Method
   OBX.17.1   Identifier
   OBX.17.2   Text
   OBX.17.3   Name of Coding System
   OBX.17.5   Alternate Text
   OBX.17.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX3
OBX.2Value TypeTS
OBX.3Observation Identifier
   OBX.3.1   Identifier29769-7Test Case Fixed
   OBX.3.2   TextVIS Presentation DateTest Case Fixed
   OBX.3.3   Name of Coding SystemLNTest Case Fixed
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Time20150715
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20150715
OBX.17Observation Method
   OBX.17.1   Identifier
   OBX.17.2   Text
   OBX.17.3   Name of Coding System
   OBX.17.5   Alternate Text
   OBX.17.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX1
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier64994-7Test Case Fixed
   OBX.3.2   Textvaccine fund pgm elig catTest Case Fixed
   OBX.3.3   Name of Coding SystemLNTest Case Fixed
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   IdentifierV01
   OBX.5.2   TextNot VFC elig
   OBX.5.3   Name of Coding SystemHL70064
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20150715
OBX.17Observation Method
   OBX.17.1   Identifier
   OBX.17.2   Text
   OBX.17.3   Name of Coding System
   OBX.17.5   Alternate Text
   OBX.17.6   Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Juana Mariana Gonzales
Mother's Maiden Name Maria Acosta
ID Number 123456 987633
Date/Time of Birth 12/23/2009
Administrative Sex F
Patient Address 1 4345 Standish Way Stamford CT 06903 USA
Patient Address 2 325 Shorline Drive Stamford CT 06901
Local Number (203)555-1212
Race Other Race
Ethnic Group Hispanic or Latino
Birth Order

Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 07/01/2012
Publicity Code Reminder/Recall - any method
Publicity Code Effective Date 07/01/2012
Protection Indicator
Protection Indicator Effective Date

Guardian or Responsible Party
Element Data
Name Joanna Merida Gonzales
Relationship Grandparent
Address 4345 Standish Way Stamford CT 06901
Phone Number or Email address (203)555-1212

Vaccine Administration Information
Element Data
Administered Code hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Date/Time Start of Administration 11/23/2009
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider Lisa Sirtis
Substance Lot Number 6332FK33
Substance Expiration Date 12/14/2010
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Left Thigh
Entering Organization Shoreline Hospital
Entered By Lisa Sirtis
Ordered By Jane Carter

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code hepatitis B vaccine, unspecified formulation
Date/Time Start of Administration 01/15/2010
Administered Amount 999
Administered Units
Administration Notes Historical Immunization
Administering Provider Sandra Molina
Substance Lot Number 6352FK1
Substance Expiration Date 10/01/2010
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Right Thigh
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Historical Immunization
Element Data


Vaccine Administration Information
Element Data
Administered Code hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Date/Time Start of Administration 10/30/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6352FK24
Substance Expiration Date 08/31/2012
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Date/Time Start of Administration 01/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS2341
Substance Expiration Date 11/30/2011
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS2433
Substance Expiration Date 09/04/2011
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 05/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS3255
Substance Expiration Date 12/01/2010
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data
Reaction fever of >40.5C (105F) within 48 hours of dose


Vaccine Administration Information
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 02/21/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS249
Substance Expiration Date 03/01/2011
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 08/31/2014
Administered Amount 999
Administered Units
Administration Notes Historical information - from other provider
Administering Provider Linda Casera
Substance Lot Number D643QS8243
Substance Expiration Date 09/01/2014
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By J Rodriguez

Historical information - from other provider
Element Data


Vaccine Administration Information
Element Data
Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 01/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M54K9245
Substance Expiration Date 03/24/2010
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M55K3342
Substance Expiration Date 10/30/2010
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 05/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M75K4566
Substance Expiration Date 05/23/2010
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 02/21/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M53K5534
Substance Expiration Date 02/22/2011
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code poliovirus vaccine, inactivated
Date/Time Start of Administration 01/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D333PV2431
Substance Expiration Date 10/04/2010
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Action Code A
Route SC
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code poliovirus vaccine, inactivated
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D333PV4344
Substance Expiration Date 03/23/2010
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Action Code A
Route SC
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code poliovirus vaccine, inactivated
Date/Time Start of Administration 02/21/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from other provider
Administering Provider Linda Casera
Substance Lot Number D335PV9644
Substance Expiration Date 02/22/2011
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Action Code A
Route SC
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By J Rodriguez

Historical information - from other provider
Element Data


Vaccine Administration Information
Element Data
Administered Code poliovirus vaccine, inactivated
Date/Time Start of Administration 05/19/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason Parental decision
Action Code A
Route
Administration Site
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data


Vaccine Administration Information
Element Data
Administered Code pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 01/21/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P243V3281
Substance Expiration Date 01/30/2010
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P343V8321
Substance Expiration Date 03/30/2010
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Action Code A
Route SC
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 05/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P853V2164
Substance Expiration Date 08/30/2010
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 02/21/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P853V58532
Substance Expiration Date 04/18/2011
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code rotavirus, live, monovalent vaccine
Date/Time Start of Administration 01/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RV533
Substance Expiration Date 02/15/2010
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code rotavirus, live, monovalent vaccine
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RV932
Substance Expiration Date 05/10/2010
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 09/25/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D8043IN8734
Substance Expiration Date 03/12/2011
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 10/27/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D8043IN8734
Substance Expiration Date 03/12/2011
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 10/02/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D9334IN9333
Substance Expiration Date 05/22/2012
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 10/15/2013
Administered Amount 999
Administered Units
Administration Notes Historical information - from parents written record
Administering Provider Gina Ricci
Substance Lot Number 8L4B3423
Substance Expiration Date 07/01/2014
Substance Manufacturer Name MedImmune, LLC
Substance/Treatment Refusal Reason
Action Code A
Route Nasal
Administration Site Bilateral Nares
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Gina Ricci

Historical information - from parents written record
Element Data


Vaccine Administration Information
Element Data
Administered Code influenza, live, intranasal, quadrivalent
Date/Time Start of Administration 07/15/2015
Administered Amount 0.2
Administered Units
Administration Notes New immunization record
Administering Provider Sandra Molina
Substance Lot Number 8L4B3521
Substance Expiration Date 08/15/2015
Substance Manufacturer Name MedImmune,LLC
Substance/Treatment Refusal Reason
Action Code A
Route Nasal
Administration Site Bilateral Nares
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

New immunization record
Element Data
VIS Publication Date 08/19/2014
VIS Presentation Date 07/15/2015
vaccine fund pgm elig cat Not VFC elig


Vaccine Administration Information
Element Data
Administered Code influenza, live, intranasal, quadrivalent
Date/Time Start of Administration 11/04/2012
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D9553IN2243
Substance Expiration Date 04/30/2012
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Date/Time Start of Administration 11/23/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RT33
Substance Expiration Date 01/24/2012
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Right Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Date/Time Start of Administration 05/23/2012
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RT48
Substance Expiration Date 09/11/2012
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code measles, mumps, rubella, and varicella virus vaccine
Date/Time Start of Administration 10/23/2010
Administered Amount 999
Administered Units
Administration Notes historical
Administering Provider J Martinez
Substance Lot Number 7W27V7491
Substance Expiration Date 12/15/2010
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Action Code A
Route Subcutaneous
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

historical
Element Data


Vaccine Administration Information
Element Data
Administered Code measles, mumps, rubella, and varicella virus vaccine
Date/Time Start of Administration 11/22/2012
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7W87V3452
Substance Expiration Date 04/13/2013
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Action Code A
Route Subcutaneous
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code measles, mumps, rubella, and varicella virus vaccine
Date/Time Start of Administration 07/15/2015
Administered Amount 0.5
Administered Units
Administration Notes New immunization record
Administering Provider Sandra Molina
Substance Lot Number 7W87V3687
Substance Expiration Date 07/15/2015
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Action Code A
Route Subcutaneous
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

New immunization record
Element Data
VIS Publication Date 05/21/2010
VIS Presentation Date 07/15/2015
vaccine fund pgm elig cat Not VFC elig


4.1.2. Receive Acknowledgement

Test Step Type: TA_RESPONDER
No Description

Test Story

Description
No Description

Comments
No Comments

PreCondition
No PreCondition

PostCondition
No PostCondition

Test Objectives
No Test Objectives

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

Message Contents

MSH : Message Header
LocationData ElemenmtDataCategrization
MSH.1Field SeparatorFieldSeperatorProfile Fixed
MSH.2Encoding CharactersEncodingProfile Fixed
MSH.3Sending Application
   MSH.3.1   Namespace IDNIST APPTest Case Fixed
   MSH.3.2   Universal ID
   MSH.3.3   Universal ID Type
MSH.4Sending Facility
   MSH.4.1   Namespace IDNIST Test Iz RegTest Case Fixed
   MSH.4.2   Universal ID
   MSH.4.3   Universal ID Type
MSH.5Receiving Application
   MSH.5.1   Namespace IDTest EHR ApplicationTest Case Fixed
   MSH.5.2   Universal ID
   MSH.5.3   Universal ID Type
MSH.6Receiving Facility
   MSH.6.1   Namespace IDX68Test Case Fixed
   MSH.6.2   Universal ID
   MSH.6.3   Universal ID Type
MSH.7Date/Time Of Message
   MSH.7.1   Time200906040000-0500System Generated
MSH.9Message Type
   MSH.9.1   Message CodeACK
   MSH.9.2   Trigger EventV04
   MSH.9.3   Message StructureACK
MSH.10Message Control IDNIST-IZ-ACK-001.01Test Case Fixed
MSH.11Processing ID
   MSH.11.1   Processing IDTTest Case Fixed
MSH.12Version ID
   MSH.12.1   Version ID2.5.1Profile Fixed
MSH.15Accept Acknowledgment TypeNEProfile Fixed
MSH.16Application Acknowledgment TypeNEProfile Fixed
MSH.21Message Profile Identifier
   MSH.21.1   Entity IdentifierZ23Profile Fixed
   MSH.21.2   Namespace IDCDCPHINVS Profile Fixed
   MSH.21.3   Universal ID
   MSH.21.4   Universal ID Type
MSH.22Sending Responsible Organization
   MSH.22.1   Organization Name
   MSH.22.6   Assigning Authority
      MSH.22.6.1      Namespace ID
      MSH.22.6.2      Universal ID
      MSH.22.6.3      Universal ID Type
   MSH.22.7   Identifier Type Code
   MSH.22.10   Organization Identifier
MSH.23Receiving Responsible Organization
   MSH.23.1   Organization Name
   MSH.23.6   Assigning Authority
      MSH.23.6.1      Namespace ID
      MSH.23.6.2      Universal ID
      MSH.23.6.3      Universal ID Type
   MSH.23.7   Identifier Type Code
   MSH.23.10   Organization Identifier

MSA : Message Acknowledgment
LocationData ElemenmtDataCategrization
MSA.1Acknowledgment CodeAATest Case Fixed
MSA.2Message Control IDNIST-IZ-001.01Test Case Fixed

4.1.3. Record an adverse reaction

Test Step Type: SUT_MANUAL
The Provider records in the EMR an adverse reaction of persistent, inconsolable crying lasting > 3 hours within 48 hours of dose.

Test Story

Description

Following the vaccine administration, the patient's mother reports that the patient that evening had persistent, inconsolable crying lasting > 3 hours.


Comments

No Comments


PreCondition

The vaccinations for the visit have been administered.


PostCondition

The adverse reaction to the MMRV  of persistent, inconsolable crying lasting > 3 hours within 48 hours of dose is recorded in the EMR.


Test Objectives

Identify Adverse Event: The EHR or other clinical software system enables capture of structured data regarding adverse events.


Evaluation Criteria

Verify that vendor can record the adverse reaction of  persistent, inconsolable crying lasting > 3 hours within 48 hours of dose correctly and without omission


Notes to Testers

No Note


4.1.4. Transmit the updated vaccination report with adverse reaction to the registry

Test Step Type: SUT_INITIATOR
The EMR generates a Z22 Send Unsolicited Immunization Update Using a VXU correctly and without omission according to supplied test data.

Test Story

Description

The adverse reaction to the MMRV of persistent, inconsolable crying lasting > 3 hours within 48 hours of dose is reported to the Immunization Registry using a Z22/VXU message.


Comments

No Comments


PreCondition

An adverse reaction to the MMRV of persistent, inconsolable crying lasting > 3 hours within 48 hours of dose is recorded in the EMR.


PostCondition

The adverse reaction has been transmitted to the IIS.


Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.


Evaluation Criteria

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.


Notes to Testers

No Note


Message Contents

MSH : Message Header
LocationData ElemenmtDataCategrization
MSH.1Field SeparatorFieldSeperator
MSH.2Encoding CharactersEncoding
MSH.3Sending Application
   MSH.3.1   Namespace IDTest EHR Application
   MSH.3.2   Universal ID
   MSH.3.3   Universal ID Type
MSH.4Sending Facility
   MSH.4.1   Namespace IDX68
   MSH.4.2   Universal ID
   MSH.4.3   Universal ID Type
MSH.5Receiving Application
   MSH.5.1   Namespace ID
   MSH.5.2   Universal ID
   MSH.5.3   Universal ID Type
MSH.6Receiving Facility
   MSH.6.1   Namespace IDNIST Test Iz Reg
   MSH.6.2   Universal ID
   MSH.6.3   Universal ID Type
MSH.7Date/Time Of Message
   MSH.7.1   Time20120701082240-0500
MSH.9Message Type
   MSH.9.1   Message CodeVXU
   MSH.9.2   Trigger EventV04
   MSH.9.3   Message StructureVXU_V04
MSH.10Message Control IDNIST-IZ-001.02
MSH.11Processing ID
   MSH.11.1   Processing IDP
MSH.12Version ID
   MSH.12.1   Version ID2.5.1
MSH.15Accept Acknowledgment TypeER
MSH.16Application Acknowledgment TypeAL
MSH.21Message Profile Identifier
   MSH.21.1   Entity IdentifierZ22
   MSH.21.2   Namespace IDCDCPHINVS
   MSH.21.3   Universal ID
   MSH.21.4   Universal ID Type
MSH.22Sending Responsible Organization
   MSH.22.1   Organization Name
   MSH.22.6   Assigning Authority
      MSH.22.6.1      Namespace ID
      MSH.22.6.2      Universal ID
      MSH.22.6.3      Universal ID Type
   MSH.22.7   Identifier Type Code
   MSH.22.10   Organization Identifier
MSH.23Receiving Responsible Organization
   MSH.23.1   Organization Name
   MSH.23.6   Assigning Authority
      MSH.23.6.1      Namespace ID
      MSH.23.6.2      Universal ID
      MSH.23.6.3      Universal ID Type
   MSH.23.7   Identifier Type Code
   MSH.23.10   Organization Identifier

PID : Patient Identification
LocationData ElemenmtDataCategrization
PID.1Set ID - PID1
PID.3Patient Identifier List
   PID.3.1   ID Number123456
   PID.3.3   Check Digit Scheme
   PID.3.4   Assigning Authority
      PID.3.4.1      Namespace IDMYEHR
      PID.3.4.2      Universal ID
      PID.3.4.3      Universal ID Type
   PID.3.5   Identifier Type CodeMR
PID.3Patient Identifier List
   PID.3.1   ID Number987633
   PID.3.3   Check Digit Scheme
   PID.3.4   Assigning Authority
      PID.3.4.1      Namespace IDMYIIS
      PID.3.4.2      Universal ID
      PID.3.4.3      Universal ID Type
   PID.3.5   Identifier Type CodeSR
PID.5Patient Name
   PID.5.1   Family Name
      PID.5.1.1      SurnameGonzalesTest Case Fixed
   PID.5.2   Given NameJuanaTest Case Fixed
   PID.5.3   Second and Further Given Names or Initials ThereofMarianaTest Case Fixed
   PID.5.7   Name Type CodeLTest Case Fixed
PID.6Mother's Maiden Name
   PID.6.1   Family Name
      PID.6.1.1      SurnameAcostaTest Case Fixed
   PID.6.7   Name Type CodeMTest Case Fixed
PID.7Date/Time of Birth
   PID.7.1   Time200912231105Test Case Fixed
PID.8Administrative SexFTest Case Fixed
PID.10Race
   PID.10.1   Identifier2131-1Test Case Fixed
   PID.10.2   TextOther RaceTest Case Fixed
   PID.10.3   Name of Coding SystemHL70005Test Case Fixed
   PID.10.5   Alternate Text
   PID.10.6   Name of Alternate Coding System
PID.11Patient Address
   PID.11.1   Street Address
      PID.11.1.1      Street or Mailing Address4345 Standish WayTest Case Fixed
   PID.11.2   Other Designation
   PID.11.3   CityStamfordTest Case Fixed
   PID.11.4   State or ProvinceCTTest Case Fixed
   PID.11.5   Zip or Postal Code06903Test Case Fixed
   PID.11.6   CountryUSATest Case Fixed
   PID.11.7   Address TypeLTest Case Fixed
PID.11Patient Address
   PID.11.1   Street Address
      PID.11.1.1      Street or Mailing Address325 Shorline Drive
   PID.11.2   Other Designation
   PID.11.3   CityStamford
   PID.11.4   State or ProvinceCTTest Case Fixed
   PID.11.5   Zip or Postal Code06901
   PID.11.6   Country
   PID.11.7   Address TypeBDLTest Case Fixed
PID.13Phone Number - Home
   PID.13.2   Telecommunication Use CodePRNTest Case Fixed
   PID.13.3   Telecommunication Equipment TypePHTest Case Fixed
   PID.13.4   Email Address
   PID.13.6   Area/City Code203Test Case Fixed
   PID.13.7   Local Number5551212Test Case Fixed
PID.22Ethnic Group
   PID.22.1   Identifier2135-2Test Case Fixed
   PID.22.2   TextHispanic or LatinoTest Case Fixed
   PID.22.3   Name of Coding SystemCDCRECTest Case Fixed
   PID.22.5   Alternate Text
   PID.22.6   Name of Alternate Coding System
PID.24Multiple Birth Indicator
PID.25Birth Order
PID.29Patient Death Date and Time
   PID.29.1   Time
PID.30Patient Death Indicator

PD1 : Patient Additional Demographic
LocationData ElemenmtDataCategrization
PD1.11Publicity Code
   PD1.11.1   Identifier02
   PD1.11.2   TextReminder/Recall - any method
   PD1.11.3   Name of Coding SystemHL70215
   PD1.11.5   Alternate Text
   PD1.11.6   Name of Alternate Coding System
PD1.12Protection Indicator
PD1.13Protection Indicator Effective Date
PD1.16Immunization Registry StatusA
PD1.17Immunization Registry Status Effective Date20120701
PD1.18Publicity Code Effective Date20120701

NK1 : Next of Kin / Associated Parties
LocationData ElemenmtDataCategrization
NK1.1Set ID - NK11
NK1.2Name
   NK1.2.1   Family Name
      NK1.2.1.1      SurnameGonzales
   NK1.2.2   Given NameJoannaTest Case Fixed
   NK1.2.3   Second and Further Given Names or Initials ThereofMeridaTest Case Fixed
   NK1.2.7   Name Type CodeLTest Case Fixed
NK1.3Relationship
   NK1.3.1   IdentifierGRPTest Case Fixed
   NK1.3.2   TextGrandparentTest Case Fixed
   NK1.3.3   Name of Coding SystemHL70063Test Case Fixed
   NK1.3.5   Alternate Text
   NK1.3.6   Name of Alternate Coding System
NK1.4Address
   NK1.4.1   Street Address
      NK1.4.1.1      Street or Mailing Address4345 Standish WayTest Case Fixed
   NK1.4.2   Other Designation
   NK1.4.3   CityStamfordTest Case Fixed
   NK1.4.4   State or ProvinceCTTest Case Fixed
   NK1.4.5   Zip or Postal Code06901Test Case Fixed
   NK1.4.6   Country
   NK1.4.7   Address TypeLTest Case Fixed
NK1.5Phone Number
   NK1.5.2   Telecommunication Use CodePRNTest Case Fixed
   NK1.5.3   Telecommunication Equipment TypePHTest Case Fixed
   NK1.5.4   Email Address
   NK1.5.6   Area/City Code203Test Case Fixed
   NK1.5.7   Local Number5551212 Test Case Fixed

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameSirtis
   ORC.10.3   Given NameLisa
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameCarter
   ORC.12.3   Given NameJane
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierSH
   ORC.17.2   TextShoreline Hospital
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20091123
RXA.5Administered Code
   RXA.5.1   Identifier08
   RXA.5.2   Texthepatitis B vaccine, pediatric or pediatric/adolescent dosage
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextENGERIX-B
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameSirtis
   RXA.10.3   Given NameLisa
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot Number6332FK33
RXA.16Substance Expiration Date
   RXA.16.1   Time20101214
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierSKB
   RXA.17.2   TextGlaxoSmithKline Biologicals SA
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMolina
   ORC.10.3   Given NameSandra
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameSmith
   ORC.12.3   Given NameFrank
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierSP
   ORC.17.2   TextShoreline Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100115
RXA.5Administered Code
   RXA.5.1   Identifier45
   RXA.5.2   Texthepatitis B vaccine, unspecified formulation
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextENGERIX-B
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier01
   RXA.9.2   TextHistorical Immunization
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMolina
   RXA.10.3   Given NameSandra
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot Number6352FK1
RXA.16Substance Expiration Date
   RXA.16.1   Time20101001
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierSKB
   RXA.17.2   TextGlaxoSmithKline Biologicals SA
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierRT
   RXR.2.2   TextRight Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20101030
RXA.5Administered Code
   RXA.5.1   Identifier08
   RXA.5.2   Texthepatitis B vaccine, pediatric or pediatric/adolescent dosage
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextENGERIX-B
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot Number6352FK24
RXA.16Substance Expiration Date
   RXA.16.1   Time20120831
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierSKB
   RXA.17.2   TextGlaxoSmithKline Biologicals SA
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100122
RXA.5Administered Code
   RXA.5.1   Identifier107
   RXA.5.2   Textdiphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextDAPTACEL
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot NumberD409QS2341
RXA.16Substance Expiration Date
   RXA.16.1   Time20111130
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierPMC
   RXA.17.2   TextSanofi Pasteur Inc
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100323
RXA.5Administered Code
   RXA.5.1   Identifier106
   RXA.5.2   Textdiphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextDAPTACEL
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot NumberD409QS2433
RXA.16Substance Expiration Date
   RXA.16.1   Time20110904
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierPMC
   RXA.17.2   TextSanofi Pasteur Inc
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierRT
   RXR.2.2   TextRight Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeLTest Case Fixed
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100522
RXA.5Administered Code
   RXA.5.1   Identifier106
   RXA.5.2   Textdiphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextDAPTACEL
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot NumberD409QS3255
RXA.16Substance Expiration Date
   RXA.16.1   Time20101201
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierPMC
   RXA.17.2   TextSanofi Pasteur Inc
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX21
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier31044-1
   OBX.3.2   TextReaction
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   IdentifierVXC12
   OBX.5.2   Textfever of >40.5C (105F) within 48 hours of dose
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20100522
OBX.17Observation Method
   OBX.17.1   Identifier
   OBX.17.2   Text
   OBX.17.3   Name of Coding System
   OBX.17.5   Alternate Text
   OBX.17.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20110221
RXA.5Administered Code
   RXA.5.1   Identifier106
   RXA.5.2   Textdiphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextDAPTACEL
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot NumberD409QS249
RXA.16Substance Expiration Date
   RXA.16.1   Time20110301
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierPMC
   RXA.17.2   TextSanofi Pasteur Inc
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMolina
   ORC.10.3   Given NameSandra
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameRodriguez
   ORC.12.3   Given NameJ
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierSP
   ORC.17.2   TextShoreline Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20140831
RXA.5Administered Code
   RXA.5.1   Identifier106
   RXA.5.2   Textdiphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextDAPTACEL
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier02
   RXA.9.2   TextHistorical information - from other provider
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameCasera
   RXA.10.3   Given NameLinda
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot NumberD643QS8243
RXA.16Substance Expiration Date
   RXA.16.1   Time20140901
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierPMC
   RXA.17.2   TextSanofi Pasteur Inc
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100122
RXA.5Administered Code
   RXA.5.1   Identifier49
   RXA.5.2   TextHaemophilus influenzae type b vaccine, PRP-OMP conjugate
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextPedvaxHIB
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot Number7M54K9245
RXA.16Substance Expiration Date
   RXA.16.1   Time20100324
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierMSD
   RXA.17.2   TextMerck Sharp \T\ Dohme Corp
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierRT
   RXR.2.2   TextRight Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100323
RXA.5Administered Code
   RXA.5.1   Identifier49
   RXA.5.2   TextHaemophilus influenzae type b vaccine, PRP-OMP conjugate
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextPedvaxHIB
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot Number7M55K3342
RXA.16Substance Expiration Date
   RXA.16.1   Time20101030
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierMSD
   RXA.17.2   TextMerck Sharp \T\ Dohme Corp
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100522
RXA.5Administered Code
   RXA.5.1   Identifier49
   RXA.5.2   TextHaemophilus influenzae type b vaccine, PRP-OMP conjugate
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextPedvaxHIB
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot Number7M75K4566
RXA.16Substance Expiration Date
   RXA.16.1   Time20100523
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierMSD
   RXA.17.2   TextMerck Sharp \T\ Dohme Corp
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierRT
   RXR.2.2   TextRight Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20110221
RXA.5Administered Code
   RXA.5.1   Identifier49
   RXA.5.2   TextHaemophilus influenzae type b vaccine, PRP-OMP conjugate
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextPedvaxHIB
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot Number7M53K5534
RXA.16Substance Expiration Date
   RXA.16.1   Time20110222
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierMSD
   RXA.17.2   TextMerck Sharp \T\ Dohme Corp
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100122
RXA.5Administered Code
   RXA.5.1   Identifier10
   RXA.5.2   Textpoliovirus vaccine, inactivated
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextIPOL
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot NumberD333PV2431
RXA.16Substance Expiration Date
   RXA.16.1   Time20101004
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierPMC
   RXA.17.2   TextSanofi Pasteur Inc
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC38299
   RXR.1.2   TextSC
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextSubcutaneous
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100323
RXA.5Administered Code
   RXA.5.1   Identifier10
   RXA.5.2   Textpoliovirus vaccine, inactivated
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextIPOL
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot NumberD333PV4344
RXA.16Substance Expiration Date
   RXA.16.1   Time20100323
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierPMC
   RXA.17.2   TextSanofi Pasteur Inc
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC38299
   RXR.1.2   TextSC
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextSubcutaneous
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMolina
   ORC.10.3   Given NameSandra
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameRodriguez
   ORC.12.3   Given NameJ
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierSP
   ORC.17.2   TextShoreline Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20110221
RXA.5Administered Code
   RXA.5.1   Identifier10
   RXA.5.2   Textpoliovirus vaccine, inactivated
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextIPOL
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier02
   RXA.9.2   TextHistorical information - from other provider
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameCasera
   RXA.10.3   Given NameLinda
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot NumberD335PV9644
RXA.16Substance Expiration Date
   RXA.16.1   Time20110222
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierPMC
   RXA.17.2   TextSanofi Pasteur Inc
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC38299
   RXR.1.2   TextSC
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextSubcutaneous
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier9999
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMolina
   ORC.10.3   Given NameSandra
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameSmith
   ORC.12.3   Given NameFrank
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierSP
   ORC.17.2   TextShoreline Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20150519
RXA.5Administered Code
   RXA.5.1   Identifier10
   RXA.5.2   Textpoliovirus vaccine, inactivated
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate Text
   RXA.5.6   Name of Alternate Coding System
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier
   RXA.9.2   Text
   RXA.9.3   Name of Coding System
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      Surname
   RXA.10.3   Given Name
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace ID
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot Number
RXA.16Substance Expiration Date
   RXA.16.1   Time
RXA.17Substance Manufacturer Name
   RXA.17.1   Identifier
   RXA.17.2   Text
   RXA.17.3   Name of Coding System
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier00
   RXA.18.2   TextParental decision
   RXA.18.3   Name of Coding SystemNIP002
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusRE
RXA.21Action Code - RXAA

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100121
RXA.5Administered Code
   RXA.5.1   Identifier133
   RXA.5.2   Textpneumococcal conjugate vaccine, 13 valent
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextPREVNAR 13
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot NumberP243V3281
RXA.16Substance Expiration Date
   RXA.16.1   Time20100130
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierPFR
   RXA.17.2   TextPfizer, Inc
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100323
RXA.5Administered Code
   RXA.5.1   Identifier133
   RXA.5.2   Textpneumococcal conjugate vaccine, 13 valent
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextPREVNAR 13
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot NumberP343V8321
RXA.16Substance Expiration Date
   RXA.16.1   Time20100330
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierPFR
   RXA.17.2   TextPfizer, Inc
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC38299
   RXR.1.2   TextSC
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextSubcutaneous
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100522
RXA.5Administered Code
   RXA.5.1   Identifier133
   RXA.5.2   Textpneumococcal conjugate vaccine, 13 valent
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextPREVNAR 13
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot NumberP853V2164
RXA.16Substance Expiration Date
   RXA.16.1   Time20100830
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierPFR
   RXA.17.2   TextPfizer, Inc
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierRT
   RXR.2.2   TextRight Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20110221
RXA.5Administered Code
   RXA.5.1   Identifier133
   RXA.5.2   Textpneumococcal conjugate vaccine, 13 valent
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextPREVNAR 13
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot NumberP853V58532
RXA.16Substance Expiration Date
   RXA.16.1   Time20110418
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierPFR
   RXA.17.2   TextPfizer, Inc
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100122
RXA.5Administered Code
   RXA.5.1   Identifier119
   RXA.5.2   Textrotavirus, live, monovalent vaccine
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextROTARIX
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot Number6359RV533
RXA.16Substance Expiration Date
   RXA.16.1   Time20100215
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierSKB
   RXA.17.2   TextGlaxoSmithKline Biologicals SA
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100323
RXA.5Administered Code
   RXA.5.1   Identifier119
   RXA.5.2   Textrotavirus, live, monovalent vaccine
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextROTARIX
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot Number6359RV932
RXA.16Substance Expiration Date
   RXA.16.1   Time20100510
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierSKB
   RXA.17.2   TextGlaxoSmithKline Biologicals SA
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierRT
   RXR.2.2   TextRight Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20100925
RXA.5Administered Code
   RXA.5.1   Identifier161
   RXA.5.2   TextInfluenza, injectable,quadrivalent, preservative free, pediatric
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextFLUZONE QUADRIVALENT
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot NumberD8043IN8734
RXA.16Substance Expiration Date
   RXA.16.1   Time20110312
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierPMC
   RXA.17.2   TextSanofi PasteurGlaxoSmithKline Biologicals SA
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLT
   RXR.2.2   TextLeft Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20101027
RXA.5Administered Code
   RXA.5.1   Identifier161
   RXA.5.2   TextInfluenza, injectable,quadrivalent, preservative free, pediatric
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextFLUZONE QUADRIVALENT
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot NumberD8043IN8734
RXA.16Substance Expiration Date
   RXA.16.1   Time20110312
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierPMC
   RXA.17.2   TextSanofi PasteurGlaxoSmithKline Biologicals SA
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierRT
   RXR.2.2   TextRight Thigh
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20111002
RXA.5Administered Code
   RXA.5.1   Identifier161
   RXA.5.2   TextInfluenza, injectable,quadrivalent, preservative free, pediatric
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextFLUZONE QUADRIVALENT
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot NumberD9334IN9333
RXA.16Substance Expiration Date
   RXA.16.1   Time20120522
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierPMC
   RXA.17.2   TextSanofi PasteurGlaxoSmithKline Biologicals SA
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMolina
   ORC.10.3   Given NameSandra
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameRicci
   ORC.12.3   Given NameGina
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierSP
   ORC.17.2   TextShoreline Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20131015
RXA.5Administered Code
   RXA.5.1   Identifier161
   RXA.5.2   TextInfluenza, injectable,quadrivalent, preservative free, pediatric
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextFLUZONE QUADRIVALENT
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier03
   RXA.9.2   TextHistorical information - from parents written record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameRicci
   RXA.10.3   Given NameGina
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot Number8L4B3423
RXA.16Substance Expiration Date
   RXA.16.1   Time20140701
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierMED
   RXA.17.2   TextMedImmune, LLC
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC38284
   RXR.1.2   TextNasal
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextNasal
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierBN
   RXR.2.2   TextBilateral Nares
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMolina
   ORC.10.3   Given NameSandra
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameSmith
   ORC.12.3   Given NameFrank
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierSP
   ORC.17.2   TextShoreline Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20150715
RXA.5Administered Code
   RXA.5.1   Identifier149
   RXA.5.2   Textinfluenza, live, intranasal, quadrivalent
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextFluMist Quadrivalent
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount0.2
RXA.7Administered Units
   RXA.7.1   IdentifiermL
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUM
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00
   RXA.9.2   TextNew immunization record
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMolina
   RXA.10.3   Given NameSandra
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot Number8L4B3521
RXA.16Substance Expiration Date
   RXA.16.1   Time20150815
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierMED
   RXA.17.2   TextMedImmune,LLC
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC38284
   RXR.1.2   TextNasal
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextNasal
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierBN
   RXR.2.2   TextBilateral Nares
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeTS
OBX.3Observation Identifier
   OBX.3.1   Identifier29768-9
   OBX.3.2   TextVIS Publication Date
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Time20140819
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20150715
OBX.17Observation Method
   OBX.17.1   Identifier
   OBX.17.2   Text
   OBX.17.3   Name of Coding System
   OBX.17.5   Alternate Text
   OBX.17.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX3
OBX.2Value TypeTS
OBX.3Observation Identifier
   OBX.3.1   Identifier29769-7
   OBX.3.2   TextVIS Presentation Date
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Time20150715
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20150715
OBX.17Observation Method
   OBX.17.1   Identifier
   OBX.17.2   Text
   OBX.17.3   Name of Coding System
   OBX.17.5   Alternate Text
   OBX.17.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX1
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier64994-7
   OBX.3.2   Textvaccine fund pgm elig cat
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   IdentifierV01
   OBX.5.2   TextNot VFC elig
   OBX.5.3   Name of Coding SystemHL70064
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20150715
OBX.17Observation Method
   OBX.17.1   Identifier
   OBX.17.2   Text
   OBX.17.3   Name of Coding System
   OBX.17.5   Alternate Text
   OBX.17.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20121104
RXA.5Administered Code
   RXA.5.1   Identifier149
   RXA.5.2   Textinfluenza, live, intranasal, quadrivalent
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextFluMist Quadrivalent
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot NumberD9553IN2243
RXA.16Substance Expiration Date
   RXA.16.1   Time20120430
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierPMC
   RXA.17.2   TextSanofi PasteurGlaxoSmithKline Biologicals SA
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameHerrera
   ORC.12.3   Given NameCarlos
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20111123
RXA.5Administered Code
   RXA.5.1   Identifier83
   RXA.5.2   Texthepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextHAVRIX
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot Number6359RT33
RXA.16Substance Expiration Date
   RXA.16.1   Time20120124
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierSKB
   RXA.17.2   TextGlaxoSmithKline Biologicals SA
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierRD
   RXR.2.2   TextRight Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameSmith
   ORC.12.3   Given NameF
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20120523
RXA.5Administered Code
   RXA.5.1   Identifier83
   RXA.5.2   Texthepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextHAVRIX
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot Number6359RT48
RXA.16Substance Expiration Date
   RXA.16.1   Time20120911
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierPMC
   RXA.17.2   TextSanofi PasteurGlaxoSmithKline Biologicals SA
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC28161
   RXR.1.2   TextIM
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextIM
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameSmith
   ORC.12.3   Given NameF
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20101023
RXA.5Administered Code
   RXA.5.1   Identifier94
   RXA.5.2   Textmeasles, mumps, rubella, and varicella virus vaccine
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextProQuad
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier01
   RXA.9.2   Texthistorical
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot Number7W27V7491
RXA.16Substance Expiration Date
   RXA.16.1   Time20101215
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierMSD
   RXA.17.2   TextMerck Sharp \T\ Dohme Corp
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC38299
   RXR.1.2   TextSubcutaneous
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextSubcutaneous
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMartinez
   ORC.10.3   Given NameJ
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameSmith
   ORC.12.3   Given NameF
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeL
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierOP
   ORC.17.2   TextOceanview Pediatrics
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20121122
RXA.5Administered Code
   RXA.5.1   Identifier94
   RXA.5.2   Textmeasles, mumps, rubella, and varicella virus vaccine
   RXA.5.3   Name of Coding SystemCVX
   RXA.5.5   Alternate TextProQuad
   RXA.5.6   Name of Alternate Coding SystemNDC
RXA.6Administered Amount999
RXA.7Administered Units
   RXA.7.1   Identifier
   RXA.7.2   Text
   RXA.7.3   Name of Coding System
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier08
   RXA.9.2   TextHistorical information - from public agency
   RXA.9.3   Name of Coding SystemNIP001
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMartinez
   RXA.10.3   Given NameJ
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot Number7W87V3452
RXA.16Substance Expiration Date
   RXA.16.1   Time20130413
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierMSD
   RXA.17.2   TextMerck Sharp \T\ Dohme Corp
   RXA.17.3   Name of Coding SystemMVX
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCP
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC38299
   RXR.1.2   TextSubcutaneous
   RXR.1.3   Name of Coding SystemNCIT
   RXR.1.5   Alternate TextSubcutaneous
   RXR.1.6   Name of Alternate Coding SystemHL70162
RXR.2Administration Site
   RXR.2.1   IdentifierLD
   RXR.2.2   TextLeft Deltoid
   RXR.2.3   Name of Coding SystemHL70163
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

ORC : Common Order
LocationData ElemenmtDataCategrization
ORC.1Order ControlRE
ORC.2Placer Order Number
   ORC.2.1   Entity Identifier
   ORC.2.2   Namespace ID
   ORC.2.3   Universal ID
   ORC.2.4   Universal ID Type
ORC.3Filler Order Number
   ORC.3.1   Entity Identifier197027
   ORC.3.2   Namespace IDDCS
   ORC.3.3   Universal ID
   ORC.3.4   Universal ID Type
ORC.10Entered By
   ORC.10.1   ID Number
   ORC.10.2   Family Name
      ORC.10.2.1      SurnameMolinaTest Case Fixed
   ORC.10.3   Given NameSandraTest Case Fixed
   ORC.10.4   Second and Further Given Names or Initials Thereof
   ORC.10.9   Assigning Authority
      ORC.10.9.2      Universal ID
      ORC.10.9.3      Universal ID Type
   ORC.10.10   Name Type Code
   ORC.10.12   Check Digit Scheme
   ORC.10.13   Identifier Type Code
ORC.12Ordering Provider
   ORC.12.1   ID Number
   ORC.12.2   Family Name
      ORC.12.2.1      SurnameSmithTest Case Fixed
   ORC.12.3   Given NameFrankTest Case Fixed
   ORC.12.4   Second and Further Given Names or Initials Thereof
   ORC.12.9   Assigning Authority
      ORC.12.9.2      Universal ID
      ORC.12.9.3      Universal ID Type
   ORC.12.10   Name Type CodeLTest Case Fixed
   ORC.12.12   Check Digit Scheme
   ORC.12.13   Identifier Type Code
ORC.17Entering Organization
   ORC.17.1   IdentifierSP
   ORC.17.2   TextShoreline PediatricsTest Case Fixed
   ORC.17.3   Name of Coding SystemHL70362
   ORC.17.5   Alternate Text
   ORC.17.6   Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
LocationData ElemenmtDataCategrization
RXA.1Give Sub-ID Counter0
RXA.2Administration Sub-ID Counter1
RXA.3Date/Time Start of Administration
   RXA.3.1   Time20150715
RXA.5Administered Code
   RXA.5.1   Identifier94Test Case Fixed
   RXA.5.2   Textmeasles, mumps, rubella, and varicella virus vaccineTest Case Fixed
   RXA.5.3   Name of Coding SystemCVXTest Case Fixed
   RXA.5.5   Alternate TextProQuadTest Case Fixed
   RXA.5.6   Name of Alternate Coding SystemNDCTest Case Fixed
RXA.6Administered Amount0.5Test Case Fixed
RXA.7Administered Units
   RXA.7.1   IdentifiermLTest Case Fixed
   RXA.7.2   Text
   RXA.7.3   Name of Coding SystemUCUMTest Case Fixed
   RXA.7.5   Alternate Text
   RXA.7.6   Name of Alternate Coding System
RXA.9Administration Notes
   RXA.9.1   Identifier00Test Case Fixed
   RXA.9.2   TextNew immunization recordTest Case Fixed
   RXA.9.3   Name of Coding SystemNIP001Test Case Fixed
   RXA.9.5   Alternate Text
   RXA.9.6   Name of Alternate Coding System
RXA.10Administering Provider
   RXA.10.1   ID Number
   RXA.10.2   Family Name
      RXA.10.2.1      SurnameMolinaTest Case Fixed
   RXA.10.3   Given NameSandraTest Case Fixed
   RXA.10.4   Second and Further Given Names or Initials Thereof
   RXA.10.9   Assigning Authority
      RXA.10.9.2      Universal ID
      RXA.10.9.3      Universal ID Type
   RXA.10.10   Name Type Code
   RXA.10.12   Check Digit Scheme
   RXA.10.13   Identifier Type Code
RXA.11Administered-at Location
   RXA.11.4   Facility
      RXA.11.4.1      Namespace IDDCS_DC
      RXA.11.4.2      Universal ID
      RXA.11.4.3      Universal ID Type
RXA.15Substance Lot Number7W87V3687Test Case Fixed
RXA.16Substance Expiration Date
   RXA.16.1   Time20150715Test Case Fixed
RXA.17Substance Manufacturer Name
   RXA.17.1   IdentifierMSDTest Case Fixed
   RXA.17.2   TextMerck Sharp \T\ Dohme CorpTest Case Fixed
   RXA.17.3   Name of Coding SystemMVXTest Case Fixed
   RXA.17.5   Alternate Text
   RXA.17.6   Name of Alternate Coding System
RXA.18Substance/Treatment Refusal Reason
   RXA.18.1   Identifier
   RXA.18.2   Text
   RXA.18.3   Name of Coding System
   RXA.18.5   Alternate Text
   RXA.18.6   Name of Alternate Coding System
RXA.20Completion StatusCPTest Case Fixed
RXA.21Action Code - RXAA

RXR : Pharmacy/Treatment Route
LocationData ElemenmtDataCategrization
RXR.1Route
   RXR.1.1   IdentifierC38299Test Case Fixed
   RXR.1.2   TextSubcutaneousTest Case Fixed
   RXR.1.3   Name of Coding SystemNCITTest Case Fixed
   RXR.1.5   Alternate TextSubcutaneousTest Case Fixed
   RXR.1.6   Name of Alternate Coding SystemHL70162Test Case Fixed
RXR.2Administration Site
   RXR.2.1   IdentifierLDTest Case Fixed
   RXR.2.2   TextLeft DeltoidTest Case Fixed
   RXR.2.3   Name of Coding SystemHL70163 Test Case Fixed
   RXR.2.5   Alternate Text
   RXR.2.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX2
OBX.2Value TypeTS
OBX.3Observation Identifier
   OBX.3.1   Identifier29768-9
   OBX.3.2   TextVIS Publication Date
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Time20100521
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20150715
OBX.17Observation Method
   OBX.17.1   Identifier
   OBX.17.2   Text
   OBX.17.3   Name of Coding System
   OBX.17.5   Alternate Text
   OBX.17.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX3
OBX.2Value TypeTS
OBX.3Observation Identifier
   OBX.3.1   Identifier29769-7
   OBX.3.2   TextVIS Presentation Date
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   Time20150715
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20150715
OBX.17Observation Method
   OBX.17.1   Identifier
   OBX.17.2   Text
   OBX.17.3   Name of Coding System
   OBX.17.5   Alternate Text
   OBX.17.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX1
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier64994-7
   OBX.3.2   Textvaccine fund pgm elig cat
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   IdentifierV01
   OBX.5.2   TextNot VFC elig
   OBX.5.3   Name of Coding SystemHL70064
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20150715
OBX.17Observation Method
   OBX.17.1   Identifier
   OBX.17.2   Text
   OBX.17.3   Name of Coding System
   OBX.17.5   Alternate Text
   OBX.17.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX1
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier64994-7
   OBX.3.2   Textvaccine fund pgm elig cat
   OBX.3.3   Name of Coding SystemLN
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   IdentifierV01
   OBX.5.2   TextNot VFC elig
   OBX.5.3   Name of Coding SystemHL70064
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20150715
OBX.17Observation Method
   OBX.17.1   Identifier
   OBX.17.2   Text
   OBX.17.3   Name of Coding System
   OBX.17.5   Alternate Text
   OBX.17.6   Name of Alternate Coding System

OBX : Observation/Result
LocationData ElemenmtDataCategrization
OBX.1Set ID - OBX21
OBX.2Value TypeCE
OBX.3Observation Identifier
   OBX.3.1   Identifier31044-1Test Case Fixed
   OBX.3.2   TextReactionTest Case Fixed
   OBX.3.3   Name of Coding SystemLNTest Case Fixed
   OBX.3.5   Alternate Text
   OBX.3.6   Name of Alternate Coding System
OBX.4Observation Sub-ID1
OBX.5Observation Value
   OBX.5.1   IdentifierVXC9
   OBX.5.2   Textpersistent, inconsolable crying lasting > 3 hours within 48 hours of dose
   OBX.5.3   Name of Coding SystemCDCPHINVS
   OBX.5.5   Alternate Text
   OBX.5.6   Name of Alternate Coding System
OBX.6Units
   OBX.6.1   Identifier
   OBX.6.2   Text
   OBX.6.3   Name of Coding System
   OBX.6.5   Alternate Text
   OBX.6.6   Name of Alternate Coding System
OBX.11Observation Result StatusF
OBX.14Date/Time of the Observation
   OBX.14.1   Time20150715
OBX.17Observation Method
   OBX.17.1   Identifier
   OBX.17.2   Text
   OBX.17.3   Name of Coding System
   OBX.17.5   Alternate Text
   OBX.17.6   Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Juana Mariana Gonzales
Mother's Maiden Name Maria Acosta
ID Number 123456 987633
Date/Time of Birth 12/23/2009
Administrative Sex F
Patient Address 1 4345 Standish Way Stamford CT 06903 USA
Patient Address 2 325 Shorline Drive Stamford CT 06901
Local Number (203)555-1212
Race Other Race
Ethnic Group Hispanic or Latino
Birth Order

Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 07/01/2012
Publicity Code Reminder/Recall - any method
Publicity Code Effective Date 07/01/2012
Protection Indicator
Protection Indicator Effective Date

Guardian or Responsible Party
Element Data
Name Joanna Merida Gonzales
Relationship Grandparent
Address 4345 Standish Way Stamford CT 06901
Phone Number or Email address (203)555-1212

Vaccine Administration Information
Element Data
Administered Code hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Date/Time Start of Administration 11/23/2009
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider Lisa Sirtis
Substance Lot Number 6332FK33
Substance Expiration Date 12/14/2010
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Left Thigh
Entering Organization Shoreline Hospital
Entered By Lisa Sirtis
Ordered By Jane Carter

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code hepatitis B vaccine, unspecified formulation
Date/Time Start of Administration 01/15/2010
Administered Amount 999
Administered Units
Administration Notes Historical Immunization
Administering Provider Sandra Molina
Substance Lot Number 6352FK1
Substance Expiration Date 10/01/2010
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Right Thigh
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Historical Immunization
Element Data


Vaccine Administration Information
Element Data
Administered Code hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Date/Time Start of Administration 10/30/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6352FK24
Substance Expiration Date 08/31/2012
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Date/Time Start of Administration 01/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS2341
Substance Expiration Date 11/30/2011
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS2433
Substance Expiration Date 09/04/2011
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 05/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS3255
Substance Expiration Date 12/01/2010
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data
Reaction fever of >40.5C (105F) within 48 hours of dose


Vaccine Administration Information
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 02/21/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS249
Substance Expiration Date 03/01/2011
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 08/31/2014
Administered Amount 999
Administered Units
Administration Notes Historical information - from other provider
Administering Provider Linda Casera
Substance Lot Number D643QS8243
Substance Expiration Date 09/01/2014
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By J Rodriguez

Historical information - from other provider
Element Data


Vaccine Administration Information
Element Data
Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 01/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M54K9245
Substance Expiration Date 03/24/2010
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M55K3342
Substance Expiration Date 10/30/2010
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 05/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M75K4566
Substance Expiration Date 05/23/2010
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 02/21/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M53K5534
Substance Expiration Date 02/22/2011
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code poliovirus vaccine, inactivated
Date/Time Start of Administration 01/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D333PV2431
Substance Expiration Date 10/04/2010
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Action Code A
Route SC
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code poliovirus vaccine, inactivated
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D333PV4344
Substance Expiration Date 03/23/2010
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Action Code A
Route SC
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code poliovirus vaccine, inactivated
Date/Time Start of Administration 02/21/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from other provider
Administering Provider Linda Casera
Substance Lot Number D335PV9644
Substance Expiration Date 02/22/2011
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Action Code A
Route SC
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By J Rodriguez

Historical information - from other provider
Element Data


Vaccine Administration Information
Element Data
Administered Code poliovirus vaccine, inactivated
Date/Time Start of Administration 05/19/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason Parental decision
Action Code A
Route
Administration Site
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data


Vaccine Administration Information
Element Data
Administered Code pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 01/21/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P243V3281
Substance Expiration Date 01/30/2010
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P343V8321
Substance Expiration Date 03/30/2010
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Action Code A
Route SC
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 05/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P853V2164
Substance Expiration Date 08/30/2010
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 02/21/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P853V58532
Substance Expiration Date 04/18/2011
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code rotavirus, live, monovalent vaccine
Date/Time Start of Administration 01/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RV533
Substance Expiration Date 02/15/2010
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code rotavirus, live, monovalent vaccine
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RV932
Substance Expiration Date 05/10/2010
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 09/25/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D8043IN8734
Substance Expiration Date 03/12/2011
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 10/27/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D8043IN8734
Substance Expiration Date 03/12/2011
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 10/02/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D9334IN9333
Substance Expiration Date 05/22/2012
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 10/15/2013
Administered Amount 999
Administered Units
Administration Notes Historical information - from parents written record
Administering Provider Gina Ricci
Substance Lot Number 8L4B3423
Substance Expiration Date 07/01/2014
Substance Manufacturer Name MedImmune, LLC
Substance/Treatment Refusal Reason
Action Code A
Route Nasal
Administration Site Bilateral Nares
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Gina Ricci

Historical information - from parents written record
Element Data


Vaccine Administration Information
Element Data
Administered Code influenza, live, intranasal, quadrivalent
Date/Time Start of Administration 07/15/2015
Administered Amount 0.2
Administered Units
Administration Notes New immunization record
Administering Provider Sandra Molina
Substance Lot Number 8L4B3521
Substance Expiration Date 08/15/2015
Substance Manufacturer Name MedImmune,LLC
Substance/Treatment Refusal Reason
Action Code A
Route Nasal
Administration Site Bilateral Nares
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

New immunization record
Element Data
VIS Publication Date 08/19/2014
VIS Presentation Date 07/15/2015
vaccine fund pgm elig cat Not VFC elig


Vaccine Administration Information
Element Data
Administered Code influenza, live, intranasal, quadrivalent
Date/Time Start of Administration 11/04/2012
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D9553IN2243
Substance Expiration Date 04/30/2012
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Date/Time Start of Administration 11/23/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RT33
Substance Expiration Date 01/24/2012
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Right Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Date/Time Start of Administration 05/23/2012
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RT48
Substance Expiration Date 09/11/2012
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Action Code A
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code measles, mumps, rubella, and varicella virus vaccine
Date/Time Start of Administration 10/23/2010
Administered Amount 999
Administered Units
Administration Notes historical
Administering Provider J Martinez
Substance Lot Number 7W27V7491
Substance Expiration Date 12/15/2010
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Action Code A
Route Subcutaneous
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

historical
Element Data


Vaccine Administration Information
Element Data
Administered Code measles, mumps, rubella, and varicella virus vaccine
Date/Time Start of Administration 11/22/2012
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7W87V3452
Substance Expiration Date 04/13/2013
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Action Code A
Route Subcutaneous
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Historical information - from public agency
Element Data


Vaccine Administration Information
Element Data
Administered Code measles, mumps, rubella, and varicella virus vaccine
Date/Time Start of Administration 07/15/2015
Administered Amount 0.5
Administered Units
Administration Notes New immunization record
Administering Provider Sandra Molina
Substance Lot Number 7W87V3687
Substance Expiration Date 07/15/2015
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Action Code A
Route Subcutaneous
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

New immunization record
Element Data
VIS Publication Date 05/21/2010
VIS Presentation Date 07/15/2015
vaccine fund pgm elig cat Not VFC elig
vaccine fund pgm elig cat Not VFC elig
Reaction persistent, inconsolable crying lasting > 3 hours within 48 hours of dose


4.1.5. Receive Acknowledgement

Test Step Type: TA_RESPONDER
No Description

Test Story

Description
No Description

Comments
No Comments

PreCondition
No PreCondition

PostCondition
No PostCondition

Test Objectives
No Test Objectives

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

Message Contents

MSH : Message Header
LocationData ElemenmtDataCategrization
MSH.1Field SeparatorFieldSeperatorProfile Fixed
MSH.2Encoding CharactersEncodingProfile Fixed
MSH.3Sending Application
   MSH.3.1   Namespace IDNIST APPTest Case Fixed
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   MSH.3.3   Universal ID Type
MSH.4Sending Facility
   MSH.4.1   Namespace IDNIST Test Iz RegTest Case Fixed
   MSH.4.2   Universal ID
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MSH.5Receiving Application
   MSH.5.1   Namespace IDTest EHR ApplicationTest Case Fixed
   MSH.5.2   Universal ID
   MSH.5.3   Universal ID Type
MSH.6Receiving Facility
   MSH.6.1   Namespace IDX68Test Case Fixed
   MSH.6.2   Universal ID
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MSH.7Date/Time Of Message
   MSH.7.1   Time200906040000-0500System Generated
MSH.9Message Type
   MSH.9.1   Message CodeACK
   MSH.9.2   Trigger EventV04
   MSH.9.3   Message StructureACK
MSH.10Message Control IDNIST-IZ-ACK-001.02Test Case Fixed
MSH.11Processing ID
   MSH.11.1   Processing IDTTest Case Fixed
MSH.12Version ID
   MSH.12.1   Version ID2.5.1Profile Fixed
MSH.15Accept Acknowledgment TypeNEProfile Fixed
MSH.16Application Acknowledgment TypeNEProfile Fixed
MSH.21Message Profile Identifier
   MSH.21.1   Entity IdentifierZ23Profile Fixed
   MSH.21.2   Namespace IDCDCPHINVS Profile Fixed
   MSH.21.3   Universal ID
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MSH.22Sending Responsible Organization
   MSH.22.1   Organization Name
   MSH.22.6   Assigning Authority
      MSH.22.6.1      Namespace ID
      MSH.22.6.2      Universal ID
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MSH.23Receiving Responsible Organization
   MSH.23.1   Organization Name
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      MSH.23.6.1      Namespace ID
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      MSH.23.6.3      Universal ID Type
   MSH.23.7   Identifier Type Code
   MSH.23.10   Organization Identifier

MSA : Message Acknowledgment
LocationData ElemenmtDataCategrization
MSA.1Acknowledgment CodeAATest Case Fixed
MSA.2Message Control IDNIST-IZ-001.02Test Case Fixed